すべてのテンプレート
Sample Templates

Patient Visit Satisfaction: Wait Times, Access & Counseling

Measures patient satisfaction with a recent healthcare visit across three domains—wait times, appointment access, and clinician counseling quality. Suitable for clinics, hospitals, and health systems seeking actionable feedback to improve the patient experience.

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
Q01
メッセージ

Welcome! This brief survey asks about one recent healthcare visit and takes about 10 minutes to complete. Your participation is entirely voluntary and you may stop at any time. There are no right or wrong answers—we simply want your honest opinions. All responses are confidential and will be reported only in aggregate to help improve care quality.

Q02
プルダウン

When was your most recent visit to this facility?

  • Within the past week
  • 1–2 weeks ago
  • 3–4 weeks ago
  • 1–2 months ago
  • 3–6 months ago
  • More than 6 months ago
Q03
プルダウン

Approximately how many minutes did you wait from check-in until you were seen by a clinician?

  • Less than 5 minutes
  • 5–14 minutes
  • 15–29 minutes
  • 30–44 minutes
  • 45–59 minutes
  • 60 minutes or more
  • Not applicable (e.g., telehealth)
Q04
オピニオンスケール

How easy was it to get an appointment when you needed one?

スケール: 1 – 7
最小:Very difficult最大:Very easy
Q05
オピニオンスケール

How clear were the clinician's explanations about your condition and care plan?

スケール: 1 – 7
最小:Not at all clear最大:Extremely clear
Q06
オピニオンスケール

Overall, how satisfied were you with this visit?

スケール: 1 – 7
最小:Not at all satisfied最大:Extremely satisfied
Q07
自由回答(長文)

Based on your responses in this survey, what is one thing we could do to improve your visit experience?

Q08
プルダウン

What is your age group?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65 or older
  • Prefer not to say
Q09
メッセージ

Thank you for completing this survey. Your feedback is valuable and will be used to help improve care quality at this facility.

Q10
プルダウン

What type of visit was it?

  • Primary care
  • Specialist
  • Urgent care
  • Emergency department (ED)
  • Telehealth / virtual visit
  • Lab or imaging only
  • Pharmacy or medication counseling
  • Other
Q11
プルダウン

After seeing the clinician, approximately how many minutes did you wait for follow-up steps (e.g., labs, pharmacy, or discharge instructions)?

  • No follow-up wait
  • Less than 5 minutes
  • 5–14 minutes
  • 15–29 minutes
  • 30–44 minutes
  • 45 minutes or more
  • Not applicable
Q12
オピニオンスケール

I was able to get an appointment within a timeframe that met my needs.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q13
選択式

Did the clinician involve you in decisions about your care to the extent you wanted?

  • Yes, completely
  • Yes, somewhat
  • Not really
  • Not at all
  • Not applicable
Q14
オピニオンスケール

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

スケール: 1 – 7
最小:Not at all likely最大:Extremely likely
Q15
AIインタビュー

We'd like to understand your experience in a bit more depth. An AI moderator will ask a couple of brief follow-up questions based on your earlier responses.

Q16
選択式

Which best describes your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q17
オピニオンスケール

Overall, how reasonable was the total time you spent waiting during this visit?

スケール: 1 – 7
最小:Very unreasonable最大:Very reasonable
Q18
オピニオンスケール

The facility offered appointment times that were convenient for my schedule.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q19
選択式

Which aspect of counseling mattered most to you during this visit?

  • Clear next steps and follow-up
  • Risks and benefits explained
  • Medication instructions
  • Lifestyle or self-care guidance
  • Time to ask questions
Q20
プルダウン

What is the highest level of education you have completed?

  • High school or less
  • Some college or associate degree
  • Bachelor's degree
  • Graduate or professional degree
  • Prefer not to say
Q21
選択式

Which method(s) did you use to book this visit? Select all that apply.

  • Phone call
  • Website or patient portal
  • Mobile app
  • Walk-in (no appointment)
  • Referral scheduled by another clinic
  • Other
Q22
オピニオンスケール

After the visit, how confident did you feel about managing your health or care plan?

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

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。

よくあるご質問

「Patient Visit Satisfaction: Wait Times, Access & Counseling」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! This brief survey asks about one recent healthcare visit and takes about 10 minutes to complete. Your participa…」・「When was your most recent visit to this facility?」・「Approximately how many minutes did you wait from check-in until you were seen by a clinician?」。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。

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