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すべてのテンプレート
Healthcare & Clinical

Post-Visit Patient Experience & NPS Survey

Measures patient satisfaction across scheduling, wait times, provider interaction, and telehealth quality using NPS and multi-dimensional experience scales for healthcare organizations seeking actionable improvement insights.

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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22問・約10分
Q01
メッセージ

Welcome to the Post-Visit Patient Experience Survey. We'd like to learn about your most recent healthcare appointment. Your honest feedback helps improve patient care. • This survey takes approximately 6–8 minutes. • There are no right or wrong answers — we value your personal experience. • Your responses are confidential and will be reported only in aggregate. • Participation is voluntary, and you may stop at any time. Please proceed when you are ready.

Q02
プルダウン

When was your most recent healthcare appointment?

  • Within the last 7 days
  • 8–30 days ago
  • 1–3 months ago
  • 3–6 months ago
  • More than 6 months ago
Q03
選択式

What type of visit was your most recent appointment?

  • In person (at clinic or hospital)
  • Video/telehealth (with video)
  • Phone (audio only)
Q04
メッセージ

We'd like you to think about your interaction with your provider during your most recent visit. Please indicate how much you agree or disagree with each of the following statements.

Q05
オピニオンスケール

Overall, how satisfied are you with your most recent healthcare visit?

スケール: 1 – 7
最小:Very dissatisfied最大:Very satisfied
Q06
メッセージ

Finally, a few optional questions about you for analysis purposes.

Q07
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.

Q08
選択式

How did you schedule that appointment?

  • Phone call to the clinic
  • Patient portal or mobile app
  • Clinic or health system website (online form)
  • In person at the clinic
  • My provider/clinic scheduled it for me
  • Other
Q09
オピニオンスケール

How satisfied were you with the wait time before your appointment began?

スケール: 1 – 7
最小:Very dissatisfied最大:Very satisfied
Q10
オピニオンスケール

My provider listened carefully to my concerns.

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 likely are you to recommend this clinic or provider to a friend or family member?

スケール: 0 – 10
最小:Not at all likely最大:Extremely likely
Q12
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
Q13
オピニオンスケール

How easy or difficult was it to schedule your appointment?

スケール: 1 – 7
最小:Very difficult最大:Very easy
Q14
オピニオンスケール

If your visit used phone or video, how would you rate the overall technology experience (audio quality, video clarity, ease of connecting)? If your visit was in person, please skip this question.

スケール: 1 – 7
最小:Very poor最大:Excellent
Q15
オピニオンスケール

My provider 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）

Please share one thing that went well and one thing that could be improved about your visit.

Q17
選択式

Which gender do you identify with?

  • Woman
  • Man
  • Non-binary
  • Prefer not to say
Q18
オピニオンスケール

My provider treated me with courtesy and respect.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q19
AIインタビュー

Based on your responses, we'd like to explore your visit experience a bit further. Please share your thoughts in a brief conversation.

Q20
プルダウン

In which country or region do you currently live?

  • United States
  • Canada
  • United Kingdom
  • Australia
  • Germany
  • France
  • India
  • Other (please specify)
  • Prefer not to say
Q21
オピニオンスケール

My provider involved me in decisions about my care.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q22
オピニオンスケール

How clear were your next steps (e.g., medications, tests, follow-up appointments) after the visit?

スケール: 1 – 7
最小:Very unclear最大:Very clear

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

  • Combines a traditional NPS question with multi-dimensional experience scales covering scheduling ease, wait-time satisfaction, telehealth technology quality, and specific provider-interaction dimensions (listening, clarity, respect, involvement in decisions) in one flow
  • Includes an AI follow-up interview that adaptively probes based on each respondent's prior answers, going beyond fixed-choice questions to surface why scores were given
  • Pairs quantitative scales with an open-text question for qualitative feedback and optional demographic questions (age, gender, region) placed at the end so they don't burden the core experience questions
  • Uses chat-message framing throughout to explain survey sections, keeping the flow transparent and reducing respondent drop-off

Jotform

Dental Patient Experience Survey Form Template

A ready-to-field form template focused specifically on dental patient experience rather than general healthcare visits. It's built on Jotform's drag-and-drop form builder, so it's easy to customize fields and branding, but it uses static form logic rather than survey-specific scaling methodology. Useful as a dental-specific starting point, not a general post-visit NPS instrument.

優れている点

  • Fielding-ready template that can be customized quickly via Jotform's form builder
  • Benefits from Jotform's broader integrations (payments, e-signatures, notifications) if a clinic already uses the platform
  • Dental-specific framing may resonate well with dental practices specifically

物足りない点

  • Static form questions with no adaptive follow-up — cannot probe further into a low satisfaction score
  • No voice AI interview or guided screen-share task option for richer qualitative context
  • Narrower scope (dental only) versus a general medical/telehealth visit experience survey

SurveyMonkey

Patient Satisfaction Survey Template

A fielding-ready post-visit patient satisfaction template from an established survey platform, directly comparable in intent to our NPS/experience survey. It likely benefits from SurveyMonkey's broad distribution and reporting tools, but the questions themselves are fixed multiple-choice/rating items. There's no indication of AI-driven follow-up or per-response quality scoring.

優れている点

  • Backed by a mature, widely-used survey platform with strong distribution and basic analytics
  • Template is purpose-built for post-visit patient satisfaction, aligning closely with common healthcare NPS use cases
  • Likely quick to deploy for teams already using SurveyMonkey

物足りない点

  • No adaptive AI follow-up questions — all respondents see the same fixed question set regardless of answers
  • No automated per-response quality scoring or transparent prompt methodology published
  • No voice AI interview or guided task/screen-share option for deeper qualitative insight

よくあるご質問

「Post-Visit Patient Experience & NPS 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 the Post-Visit Patient Experience Survey. We'd like to learn about your most recent healthcare appointment.…」・「When was your most recent healthcare appointment?」・「What type of visit was your most recent appointment?」。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。

このテンプレートを使う無料で始める

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