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Healthcare & Clinical

Medical Examination & Check-Up Experience Survey

Captures how patients experience scheduling, wait times, communication, and results delivery during routine or diagnostic medical exams. Includes a best-worst trade-off to prioritize service improvements and an AI follow-up interview that reconstructs what actually happened during the visit — especially around how results were explained — rather than just a satisfaction score.

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設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全12問・約7分
Q01
メッセージ

Thanks for taking a few minutes to share feedback on your recent medical exam or check-up. Your responses are completely confidential and anonymized. Your honest answers help the clinic improve patient care. This should take about 5 minutes.

Q02
選択式必須

Which best describes the exam or check-up you recently had?

  • Annual physical / general check-up
  • Specialist diagnostic exam (e.g., imaging, cardiac, women's/men's health)
  • Preventive screening (e.g., blood work, cancer screening)
  • Pre-employment or insurance-required exam
  • Follow-up exam for an existing condition
  • Other
Q03
オピニオンスケール必須

How easy was it to schedule this appointment?

スケール: 1 – 7
最小:Very difficult最大:Very easy
Q04
評価スケール

How would you rate the friendliness and helpfulness of the front-desk / check-in staff?

範囲: 1 – 5
最小:Poor最大:Excellent
Q05
マトリクス必須

Thinking about the exam itself, how much do you agree with each statement?

5行 × 5列
  • The wait time before being seen was reasonable
  • The exam felt thorough and unrushed
  • The provider explained what they were doing and why
  • The facility felt clean and well-organized
  • My results were explained in a way I understood
列: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q06
オピニオンスケール必須

How likely are you to recommend this clinic for a similar exam to a friend or family member?

スケール: 0 – 10
最小:Not at all likely最大:Extremely likely
Q07
ベスト・ワースト選択（MaxDiff）

If the clinic could only improve a few things, which of these matter most to you, and which matter least?

  • Shorter wait times
  • Lower out-of-pocket cost
  • Clearer explanation of results
  • Friendlier staff
  • Cleaner, more comfortable facility
  • Easier online scheduling
  • Faster follow-up after the visit
各セットで最も良いもの・最も悪いものを選択最も良い:Matters most最も悪い:Matters least
Q08
AIインタビュー

Reconstruct exactly what happened when the respondent's results were shared with them: who explained them, what was said, whether they understood next steps, and whether anything was left unclear or worrying. If they gave a low recommend score, probe for the single most negative moment of the visit and what would have fixed it in the moment; if high, probe what specifically stood out as exceptional.

Q09
自由回答（長文）

Is there anything else about your exam experience — good or bad — you'd like the clinic to know?

Q10
選択式

What is your age range? (optional)

  • Under 25
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65 or older
  • Prefer not to say
Q11
選択式

What is your gender? (optional)

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q12
メッセージ

Thank you for sharing your experience! Your responses will be reviewed by the clinic's patient experience team to improve scheduling, communication, and overall care quality.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Includes a best-worst (MaxDiff) trade-off question so clinics know which specific improvements (scheduling, wait times, communication, results delivery) to prioritize, rather than a flat satisfaction average.
  • Uses an AI follow-up interview specifically to reconstruct what actually happened when the patient's results were shared — surfacing miscommunication or gaps in explanation that a scale question would miss.
  • Combines a matrix of agreement statements about the exam itself with opinion-scale questions on scheduling ease and likelihood to recommend, giving both structured and open-ended signal in one flow.
  • Closes with an open-ended long-text question and optional demographics, so qualitative detail and benchmarking data are captured without forcing every respondent to answer them.

QuestionPro

Medical Examination Services Survey Template

A ready-to-field static survey template covering patient experience of medical examination services, built on QuestionPro's standard survey engine. It's directly comparable in topic and intent to our template, focused on patient-reported experience rather than clinical documentation. Customization relies on QuestionPro's usual question library rather than adaptive interviewing.

優れている点

  • Fielding-ready template purpose-built for medical examination patient experience, not a generic form repurposed for this use case
  • Backed by QuestionPro's broad survey feature set (logic, multiple question types, reporting dashboards)
  • Likely easy to customize and deploy quickly for clinics already familiar with QuestionPro

物足りない点

  • Static question set with no adaptive AI follow-up to probe deeper into how results or diagnoses were actually communicated
  • No indication of per-response automated quality scoring to flag low-effort or contradictory answers
  • No published transparent methodology or prompt logic behind how questions are interpreted or scored

よくあるご質問

「Medical Examination & Check-Up Experience Survey」テンプレートにはどのような設問が含まれていますか？

すぐに使える設問が12問含まれており、最初の設問は次のとおりです：「Thanks for taking a few minutes to share feedback on your recent medical exam or check-up. Your responses are completely…」・「Which best describes the exam or check-up you recently had?」・「How easy was it to schedule this appointment?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか？

回答者は通常、12問を約7分で回答し終えます。

テンプレートは編集できますか？

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか？

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか？

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

このテンプレートを使う無料で始める

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