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すべてのテンプレート
Industry-Specific

Patient Visit Experience Survey (CAHPS-Aligned)

Measures how a patient experienced a specific provider visit — getting the appointment, provider communication, staff courtesy, and an overall rating — modeled on the CAHPS Clinician & Group Visit 2.0 survey used across medical practices and health systems. An AI follow-up interview digs into the exact moment or interaction that drove the patient's overall rating, turning a single number into an actionable story.

このテンプレートを使うほかのテンプレートを見る

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13問・約7分
Q01
メッセージ

Thanks for taking a few minutes to tell us about your recent visit. Your honest feedback helps this practice improve care for patients like you. Your responses are completely confidential and anonymized. This should take about 7 minutes.

Q02
選択式

Was this the first time you saw this particular provider?

  • Yes, first visit
  • No, I've seen this provider before
Q03
選択式必須

How many days passed between when you first tried to schedule this appointment and the day you were actually seen?

  • Same day
  • 1-3 days
  • 4-7 days
  • 1-2 weeks
  • More than 2 weeks
Q04
マトリクス必須

Thinking about this visit, how often did your provider do each of the following?

5行 × 4列
  • Explained things in a way you could understand
  • Listened carefully to you
  • Seemed to know important information about your medical history
  • Showed respect for what you had to say
  • Spent enough time with you
列: Never · Sometimes · Usually · Always
Q05
選択式必須

Thinking about the front-desk and office staff during this visit, how often were they courteous and helpful to you?

  • Never
  • Sometimes
  • Usually
  • Always
Q06
オピニオンスケール必須

Using a 0-10 scale, how would you rate this provider overall?

スケール: 0 – 10
最小:Worst provider possible最大:Best provider possible
Q07
選択式必須

How likely are you to recommend this provider to friends and family?

  • Definitely not
  • Probably not
  • Probably yes
  • Definitely yes
Q08
AIインタビュー

Probe why the respondent gave the overall rating they did: ask them to describe the specific moment or interaction during this visit that most shaped that score. If the rating was high, find out what exactly stood out as exceptional and worth protecting; if it was middling or low, identify the single biggest fix that would raise it and whether it traces back to the provider's communication, the wait, or the staff. Anchor every follow-up on concrete details from this specific visit rather than general impressions of the practice.

Q09
選択式

In general, how would you rate your overall health?

  • Excellent
  • Very good
  • Good
  • Fair
  • Poor
  • Prefer not to say
Q10
選択式

Which age range do you fall into?

  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65-74
  • 75 or older
  • Prefer not to say
Q11
選択式

How do you describe your gender?

  • Man
  • Woman
  • Non-binary
  • Prefer not to say
Q12
プルダウン

What is the highest level of education you have completed?

  • Less than high school
  • High school graduate
  • Some college
  • Bachelor's degree
  • Graduate or professional degree
  • Prefer not to say
Q13
メッセージ

Thank you for sharing your experience! Your responses feed directly into this practice's patient experience reports and help guide improvements to scheduling, communication, and staff training.

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

  • Uses the same core structure as the CAHPS Clinician & Group visit survey — appointment access, provider communication, staff courtesy, and an overall 0-10 rating — so results are benchmarkable against a recognized standard
  • Pairs the overall rating with an AI follow-up interview that asks the patient to describe the exact moment or interaction that drove their score, turning a number into a specific, actionable story
  • Includes a matrix question on specific provider communication behaviors and a separate staff-courtesy question, so low scores can be traced to the front desk or the clinician
  • Collects standard case-mix variables (general health, age range, gender, education) so results can be segmented and fairly compared across patient groups

SurveyMonkey

Patient Satisfaction Survey Template

A ready-to-field, static patient satisfaction survey covering visit basics and satisfaction ratings. It's a solid general-purpose template but is not explicitly modeled on the CAHPS visit survey structure and doesn't publish its underlying question methodology.

優れている点

  • Fielding-ready template usable immediately without custom build-out
  • Backed by SurveyMonkey's broad distribution, panel, and analytics infrastructure
  • Familiar, easy-to-deploy survey format for healthcare practices

物足りない点

  • Fixed question set with no adaptive follow-up to probe why a patient gave a particular rating
  • No voice-based interview option for patients who prefer speaking over typing
  • No automated per-response quality scoring or transparent prompt/methodology disclosure

SurveySparrow

Doctor Visit Form Template

A conversational-style form template for capturing doctor visit details, benefiting from SurveySparrow's chat-like UI. It reads as a general visit form rather than a CAHPS-aligned experience survey, and there's no indication it drills into the reasoning behind a patient's overall rating.

優れている点

  • Chat-style interface that can feel more conversational than a traditional form
  • Fielding-ready template for quick deployment
  • Mobile-friendly design typical of SurveySparrow's product

物足りない点

  • Conversational UI is scripted, not adaptive — it can't generate a genuine follow-up question based on a specific answer
  • No voice AI interview option for patients
  • No mechanism to automatically score response quality or surface the exact moment driving a low or high rating

よくあるご質問

「Patient Visit Experience Survey (CAHPS-Aligned)」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13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 tell us about your recent visit. Your honest feedback helps this practice improve car…」・「Was this the first time you saw this particular provider?」・「How many days passed between when you first tried to schedule this appointment and the day you were actually seen?」。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、13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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