Healthcare & Clinical

Patient Waiting List Experience Survey

Captures how patients experience the wait between referral and treatment — expectations vs. reality, communication quality, anxiety, and health impact — for clinics and health systems managing waiting lists. An AI follow-up interview digs into the specific moment communication broke down or worked well, surfacing fixes that satisfaction scores alone can't show.

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設問の例

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全13問・約7分

Q01

メッセージ

Thanks for taking a few minutes to share your experience while waiting for care. Your answers help us reduce stress and confusion for future patients. Your responses are completely confidential and anonymized. This should take about 5 minutes, and there are no wrong answers.

Q02

選択式必須

What type of appointment or procedure were you waiting for?

Specialist consultation
Diagnostic test or scan
Surgery or procedure
Follow-up appointment
Other

Q03

数値必須

Roughly how many weeks passed between your referral and your appointment or procedure?

Q04

オピニオンスケール必須

Compared to what you were originally told, how did the actual wait feel?

スケール: 1 – 5

最小:Much longer than expected最大:Much shorter than expected

Q05

マトリクス必須

Thinking about how the clinic communicated with you during the wait, how would you rate each of the following?

4行 × 5列

Being told how long the wait would likely be
Receiving updates while you waited
How easy it was to reach someone with questions
Being told what to do if your condition changed

列: Poor · Fair · Good · Very good · Excellent

Q06

オピニオンスケール必須

How anxious or stressed did the waiting period make you feel?

スケール: 1 – 7

最小:Not at all anxious最大:Extremely anxious

Q07

選択式必須

While you were waiting, did your condition change?

Got worse
Stayed about the same
Improved
Not sure

Q08

選択式

During the wait, did you seek care elsewhere (for example, an emergency room, urgent care, or a private provider)?

No, I waited it out
Yes, once
Yes, more than once

Q09

評価スケール必須

Overall, how satisfied were you with your experience on the waiting list, from referral to being seen?

範囲: 1 – 5

最小:Very dissatisfied最大:Very satisfied

Q10

AIインタビュー

Explore the specific moment during the wait that most shaped the respondent's overall satisfaction rating — ask them to walk through what happened, what they expected versus what occurred, and how the clinic communicated (or didn't) at that point. If they reported worsening symptoms or seeking outside care, probe what would have prevented that and whether they felt anyone was tracking their case. If satisfaction was high, identify exactly what communication or reassurance made the difference so it can be replicated.

Q11

選択式

What is your age range?

Under 18
18-29
30-44
45-59
60-74
75 or older
Prefer not to say

Q12

選択式

How do you describe your gender?

Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say

Q13

メッセージ

Thank you for sharing your experience. Your responses will be combined with other patients' feedback to help our team shorten waits and improve communication for people currently on the list.

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

Goes beyond a satisfaction score with a matrix question rating communication quality across multiple dimensions and an opinion-scale item comparing expected vs. actual wait, so you see where the gap actually opened up
Includes an AI follow-up interview that probes the specific moment during the wait that most shaped the patient's overall experience, surfacing concrete fixes rather than just a number
Captures downstream impact often missed by simple wait-time forms: anxiety/stress level, whether the condition changed, and whether the patient sought care elsewhere (e.g., ER/urgent care) while waiting
Full patient journey covered end-to-end — referral timing, communication quality, emotional impact, outcome-related behavior, overall satisfaction, and demographics — in one fieldable, auto-reported survey

Jotform

Patient Waiting List Form Template

This is a drag-and-drop form for logging patients onto a waiting list (contact info, appointment type) rather than a survey exploring how the wait felt to them. It's fielding-ready for intake/logistics, but not built to capture expectation gaps, anxiety, or communication quality. Best suited to list management, not experience research.

優れている点

Easy drag-and-drop customization and clinic branding
Wide range of integrations (payment, calendar, CRM) common to Jotform's ecosystem
Simple to embed on a clinic or health system website

物足りない点

Static field-based form with no adaptive follow-up questioning into why or how communication broke down
No built-in scoring of response quality or automated interpretive reporting
No voice AI interview option for patients who prefer speaking over typing

SurveySparrow

Free Patient Waiting List Form Template

SurveySparrow's version is also framed as a waiting list intake form with a conversational, chat-like UI, rather than a deep-dive experience survey. It's ready to field for collecting waitlist entries, but the template as titled doesn't appear designed to probe anxiety, communication breakdowns, or downstream care-seeking behavior. Positioned more for list intake than experience insight.

優れている点

Conversational, mobile-friendly form format that can feel less clinical to fill out
Supports multi-channel distribution (web, email, link sharing)
Easy branching for basic form logic

物足りない点

No adaptive AI interviewing to dig into the specific moment a patient's experience turned positive or negative
No transparent, inspectable AI prompt or automated per-response quality scoring
Lacks structured measurement of expectation-vs-reality gaps or health impact during the wait

よくあるご質問