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すべてのテンプレート
Healthcare & Clinical

Patient Visit Experience: Pain, Communication & Discharge

Measures patient satisfaction across pain management, provider communication, and discharge preparedness for inpatient, outpatient, emergency, and telehealth visits.

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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25問・約11分
Q01
メッセージ

Welcome to this patient experience survey. We are collecting feedback to improve the quality of care at our facility. This survey is voluntary and you may stop at any time. There are no right or wrong answers — we are interested in your honest opinions. Your responses are confidential and will be reported only in aggregate. The survey takes approximately 11 minutes to complete. Thank you for your time.

Q02
プルダウン

When was your most recent healthcare visit?

  • In the last 7 days
  • 8–14 days ago
  • 15–30 days ago
  • 1–3 months ago
  • More than 3 months ago
Q03
選択式

Did you experience pain during this visit?

  • Yes
  • No
Q04
オピニオンスケール

How well did healthcare staff listen to your concerns during this visit?

スケール: 1 – 7
最小:Not at all well最大:Extremely well
Q05
オピニオンスケール

Before I left, I clearly understood my discharge or after-visit instructions.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q06
オピニオンスケール

Overall, how would you rate the quality of care you received during this visit?

スケール: 1 – 7
最小:Very poor最大:Excellent
Q07
プルダウン

What is your age group?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65–74
  • 75 or older
  • Prefer not to say
Q08
メッセージ

Thank you for completing this survey. Your feedback helps us improve the quality of care we provide. Your responses are confidential and will be reviewed in aggregate. If you have an urgent medical concern, please contact your healthcare provider directly.

Q09
選択式

What type of healthcare visit was it?

  • Emergency department
  • Inpatient hospital stay (overnight)
  • Outpatient clinic or urgent care
  • Telehealth / virtual visit
  • Other (please specify)
Q10
オピニオンスケール

Healthcare staff took my pain seriously during this visit.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q11
オピニオンスケール

How clear was the information you received about your condition or treatment plan?

スケール: 1 – 7
最小:Not at all clear最大:Extremely clear
Q12
オピニオンスケール

I understood what medications to take and when to take them.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q13
オピニオンスケール

How likely are you to recommend this healthcare facility to a friend or family member?

スケール: 1 – 7
最小:Not at all likely最大:Extremely likely
Q14
選択式

How do you describe your gender? Select all that apply.

  • Woman
  • Man
  • Non-binary
  • Another gender identity
  • Prefer not to say
Q15
オピニオンスケール

Staff responded promptly when I reported pain.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q16
選択式

Did healthcare staff give you enough time to ask questions?

  • Yes, definitely
  • Yes, somewhat
  • No
Q17
オピニオンスケール

I knew what warning signs or symptoms to watch for after leaving.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q18
自由回答（長文）

Based on your responses in this survey, please share any additional thoughts or feelings about your visit experience.

Q19
プルダウン

What is your current employment status?

  • Employed full-time
  • Employed part-time
  • Self-employed
  • Unemployed
  • Student
  • Retired
  • Unable to work
  • Prefer not to say
Q20
オピニオンスケール

My pain was well controlled during this visit.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q21
オピニオンスケール

I knew who to contact if I had questions or concerns after leaving.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q22
AIインタビュー

Thank you for your written feedback. We'd like to ask a couple of brief follow-up questions to better understand your experience.

Q23
選択式

Which methods were used to manage your pain? Select all that apply.

  • Oral medication
  • IV or injection medication
  • Ice or heat
  • Positioning or movement
  • Relaxation or breathing techniques
  • Other (please specify)
  • None of the above
Q24
オピニオンスケール

How confident did you feel managing your health after leaving?

スケール: 1 – 7
最小:Not at all confident最大:Extremely confident
Q25
選択式

Which of the following supports did you receive before leaving? Select all that apply.

  • Written instructions provided
  • Demonstration or teach-back used
  • Follow-up appointment scheduled
  • Prescription(s) arranged before leaving
  • Transportation support provided
  • Home care or community support arranged
  • None of the above
  • Not applicable

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

  • Covers the full care journey in one instrument — visit type (inpatient/outpatient/ER/telehealth), pain management, provider communication, and discharge preparedness — rather than isolating a single stage like intake or discharge alone.
  • Uses granular opinion-scale items (pain taken seriously, prompt response to pain, staff listening, clarity of information, understanding of medications/warning signs/follow-up contacts) to pinpoint exactly where experience breaks down.
  • Pairs an open-text reflection question with an AI follow-up interview that probes deeper into whatever themes the patient raises, instead of ending data collection at a static free-text box.
  • Adds demographic dropdowns (age, gender, employment) for segmentation and applies automated per-response quality scoring, giving cleaner, analysis-ready data than a plain form export.

SurveyMonkey

Patient Satisfaction Survey Template

A ready-to-field, static post-visit satisfaction survey covering typical experience dimensions. It's a genuine comparable offering for this topic, built on SurveyMonkey's established survey infrastructure. It relies on fixed question sets rather than adaptive questioning.

優れている点

  • Backed by a widely used, established survey platform with broad distribution options
  • Pre-built template reduces setup time for a standard patient satisfaction study
  • Likely supports basic branching/skip logic common to SurveyMonkey templates

物足りない点

  • Static question set with no adaptive AI follow-up to probe open-ended answers
  • No voice-based interview option or guided screen-share tasks
  • No automated per-response quality scoring or transparent prompt methodology

Typeform

Patient Discharge Form Template

This is primarily a discharge documentation form rather than a full patient-experience or satisfaction survey — it appears narrower in scope, focused on the discharge step rather than pain management and communication across visit types. Still relevant as a point of comparison for the discharge-preparedness portion of a patient feedback program.

優れている点

  • Typeform's conversational, one-question-at-a-time interface is mobile-friendly and easy to complete
  • Clean design likely improves completion rates for shorter discharge-focused forms

物足りない点

  • Narrow focus on discharge only, without coverage of pain management or in-visit communication
  • Static form with no adaptive AI questioning or voice interview option
  • No automated report generation or response-level quality scoring

よくあるご質問

「Patient Visit Experience: Pain, Communication & Discharge」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25問含まれており、最初の設問は次のとおりです：「Welcome to this patient experience survey. We are collecting feedback to improve the quality of care at our facility. Th…」・「When was your most recent healthcare visit?」・「Did you experience pain during this visit?」。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、25問を約11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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