Q01
メッセージ
すべてのテンプレートHealthcare & Clinical
Patient Visit Satisfaction & Communication Survey
Assesses patient experience across scheduling access, clinician communication, post-visit follow-up, and overall satisfaction to identify actionable care quality improvements.
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22問・約10分
Q02
選択式
What type of visit is this feedback about?
- Primary care
- Specialist
- Urgent care
- Telehealth / video visit
- Nurse-only visit
- Emergency department
- Other
Q03
オピニオンスケール
How easy was it to reach the clinic to schedule your visit or ask a question?
スケール: 1 – 7
最小:Very difficult最大:Very easy
Q04
メッセージ
The following questions ask about the clinician you saw during this visit. Please indicate how much you agree or disagree with each statement.
Q05
オピニオンスケール
How clear were the next steps you were given after your visit (e.g., medications, tests, or self-care instructions)?
スケール: 1 – 7
最小:Not at all clear最大:Extremely clear
Q06
評価スケール
Overall, how would you rate your experience with this visit?
範囲: 1 – 5
最小:Very poor最大:Excellent
Q07
プルダウン
What is your age?
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65 or older
- Prefer not to say
Q08
メッセージ
Thank you for completing this survey. Your feedback is valuable and will be used to improve the care experience for all patients.
Q09
プルダウン
When did this visit take place?
- Within the past 7 days
- 8–30 days ago
- 31–90 days ago
- 3–12 months ago
- More than a year ago
Q10
選択式
How did you contact the clinic before or after your visit? Select all that apply.
- Phone call
- Patient portal / online message
- Clinic website form
- Mobile app
- Text / SMS
- Walk-in
- Did not contact the clinic
- Other
Q11
オピニオンスケール
The clinician listened carefully to me.
スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q12
選択式
Which of the following did you receive after your visit? Select all that apply.
- Written after-visit summary
- Instructions via patient portal or message
- A follow-up appointment or plan
- Contact information for questions
- Medication instructions
- Test results within the expected timeframe
- I did not need any follow-up
- I am still waiting for follow-up information
Q13
オピニオンスケール
How likely are you to recommend this clinic to a friend or family member?
スケール: 0 – 10
最小:Not at all likely最大:Extremely likely
Q14
選択式
What is your gender identity?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q15
オピニオンスケール
The clinician explained things in a way I could understand.
スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q16
自由回答（長文）
Based on your responses, is there anything else you would like to share about your visit experience?
Q17
プルダウン
What is the highest level of education you have completed?
- Less than high school
- High school or equivalent
- Some college / Associate degree
- Bachelor's degree
- Postgraduate degree
- Prefer not to say
Q18
オピニオンスケール
The clinician showed respect for what I had to say.
スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q19
AIインタビュー
Thank you for your responses so far. To help us better understand your experience, an AI moderator will ask a couple of brief follow-up questions.
Q20
プルダウン
What is your current employment status?
- Employed full-time
- Employed part-time
- Self-employed
- Student
- Unemployed
- Retired
- Not working for pay
- Prefer not to say
Q21
オピニオンスケール
The clinician spent enough time with me.
スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q22
オピニオンスケール
I felt involved in decisions about my care.
スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
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 dedicated opinion-scale questions on clinician listening, explanation clarity, respect, time spent, and involvement in care decisions — not just a single satisfaction score
- Uses an AI follow-up interview after the structured questions to let patients elaborate on their experience in their own words, going beyond a static open-text box
- Covers the full visit journey — scheduling access, contact channels, clinician communication, post-visit follow-up materials, and overall/NPS-style ratings — in one flow
- Separates demographic questions (age, gender identity, education, employment) at the end so they don't bias earlier responses, with transparent, auditable question logic throughout
SurveyMonkey
Patient Satisfaction Survey TemplateA ready-to-field template covering standard post-visit satisfaction topics. It's built on SurveyMonkey's established survey infrastructure with broad distribution and analytics options. Like most static templates, it relies on fixed question sets rather than adaptive probing.
優れている点
- Well-known, mature survey platform with reliable distribution and reporting tools
- Template is pre-built and ready to deploy quickly
- Likely benefits from SurveyMonkey's broad question-type library and benchmarking features
物足りない点
- No adaptive AI follow-up questioning — all respondents see the same fixed question path
- No voice AI interview or screen-share task option for richer qualitative feedback
- No published methodology on how question wording or scoring logic was derived
SurveySparrow
Free Patient Satisfaction Survey TemplateA free, healthcare-specific patient satisfaction template with a conversational chat-style survey format. It's positioned as a quick-start template rather than an AI-driven interview experience. Good for basic feedback collection but limited for deeper qualitative follow-up.
優れている点
- Conversational, chat-like UI that can feel more engaging than a traditional form
- Healthcare-specific template framing tailored to patient satisfaction
- Free to use as a starting point
物足りない点
- No adaptive AI-driven follow-up interviewing based on individual answers
- No automated per-response quality scoring
- No voice-based interview option for patients who prefer speaking over typing
Jotform
Patient Satisfaction Survey Form TemplateA customizable form-builder template for collecting patient satisfaction feedback, part of Jotform's large general-purpose template library. It's flexible for form design but is a static form product rather than an interview-style research tool. No indication of adaptive questioning or AI-driven analysis.
優れている点
- Highly customizable form fields and layout via Jotform's drag-and-drop builder
- Large ecosystem of integrations (payments, CRMs, notifications)
- Easy to embed on clinic websites or share via link
物足りない点
- Static form structure with no adaptive AI follow-up questions
- No voice AI interview or guided screen-share task capability
- No automated quality scoring of open-text responses or auto-generated insight reports
よくあるご質問
「Patient Visit Satisfaction & Communication 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22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 gathering feedback about a recent healthcare visit to help improve car…」・「What type of visit is this feedback about?」・「How easy was it to reach the clinic to schedule your visit or ask a question?」。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、22問を約10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。
関連テンプレート
似たテーマのほかの調査もご覧ください。