すべてのテンプレート
Healthcare & Clinical

Post-Visit Patient Support & Education Experience Survey

Measures patient perceptions of post-visit support access, health education clarity, and care coordination quality. Designed for healthcare organizations seeking to identify gaps in patient communication and follow-up processes.

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, and thank you for participating. This brief survey (approximately 10 minutes) asks about your most recent healthcare visit. Your participation is voluntary and you may stop at any time. There are no right or wrong answers — we are interested in your honest opinions. All responses are confidential and will be reported only in aggregate to help improve patient care.

Q02
選択式

When was your most recent healthcare visit?

  • Within the last 30 days
  • 1–3 months ago
  • 3–6 months ago
  • 6–12 months ago
  • More than 12 months ago
  • I have not had a visit in the past 12 months
Q03
オピニオンスケール

How easy was it to reach your care team when you needed help?

スケール: 1 – 7
最小:Very difficult最大:Very easy
Q04
オピニオンスケール

The explanations I received about my condition and treatment were clear and easy to understand.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q05
オピニオンスケール

The different providers involved in my care seemed to share information effectively with each other.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q06
オピニオンスケール

How confident are you in managing your health based on what you learned during your visit?

スケール: 1 – 7
最小:Not at all confident最大:Extremely confident
Q07
AIインタビュー

We'd like to understand your experience in more detail. An AI moderator will ask you a couple of brief follow-up questions about the support and education you received.

Q08
プルダウン

What is your age?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65–74
  • 75+
  • 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 improve patient support, education, and care coordination.

Q10
選択式

What type of care setting did you visit most recently?

  • Primary care / family medicine
  • Specialist clinic
  • Hospital outpatient clinic
  • Emergency or urgent care
  • Telehealth / virtual visit
  • Behavioral or mental health
  • Other
Q11
選択式

Which of the following support channels did you use to get help? Select all that apply.

  • Phone call
  • Patient portal messages
  • Email
  • Text / SMS
  • In-person nurse line or walk-in
  • 24/7 helpline
  • Support group or peer navigator
  • None of the above
  • Other
Q12
選択式

Were your questions answered in a way you could understand?

  • Yes, completely
  • Yes, somewhat
  • No
  • I did not have questions
Q13
選択式

Before you left, did you have a clear plan for your next steps in care?

  • Yes, a written plan
  • Yes, a verbal plan only
  • Partly
  • No
  • Not applicable
Q14
オピニオンスケール

How likely are you to recommend this clinic or care team to a friend or family member?

スケール: 0 – 10
最小:Not at all likely最大:Extremely likely
Q15
自由回答(長文)

What went particularly well during your most recent visit?

Q16
選択式

Which best describes your gender?

  • Woman
  • Man
  • Non-binary
  • Another identity
  • Prefer not to say
Q17
選択式

Which of the following educational resources did you find useful during or after your visit? Select all that apply.

  • Printed handouts or brochures
  • Videos or multimedia content
  • Patient portal articles or guides
  • Verbal explanations from a provider
  • Online resources recommended by the care team
  • Mobile app or digital tools
  • None of the above
  • I was not offered educational resources
  • Other
Q18
プルダウン

If you were referred to another provider, approximately how long did you wait between the referral and the appointment?

  • Less than 1 week
  • 1–2 weeks
  • 2–4 weeks
  • 1–2 months
  • More than 2 months
  • I am still waiting
  • Not applicable — I was not referred
Q19
自由回答(長文)

Based on your responses in this survey, is there anything else we could improve about support, education, or care coordination?

Q20
プルダウン

Where do you currently live?

  • United States
  • Canada
  • United Kingdom
  • Australia
  • India
  • Other
  • Prefer not to say
Q21
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 or technical training
  • Bachelor's degree
  • Graduate or professional degree
  • Prefer not to say
Q22
選択式

Do you currently live with any ongoing health conditions? Select all that apply.

  • Diabetes
  • Heart or circulatory condition
  • Respiratory condition (e.g., asthma, COPD)
  • Mental health condition
  • Musculoskeletal or pain condition
  • Neurological condition
  • None of the above
  • Other
  • Prefer not to say

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 an AI follow-up interview segment that adaptively probes on the specifics of each patient's experience, going beyond fixed-choice ratings
  • Separately measures three distinct dimensions—access to post-visit support, clarity of health education, and cross-provider care coordination—rather than a single general satisfaction score
  • Captures concrete process gaps such as referral wait times and which support channels or educational resources were actually used
  • Closes with open-ended questions on what went well and what could improve, giving qualitative context to the quantitative scores

SurveyMonkey

Patient Satisfaction Survey Template

This is a ready-to-field static template focused on general post-visit satisfaction rather than a deep dive into support access, education clarity, or care coordination specifically. It's backed by SurveyMonkey's established survey infrastructure and benchmarking tools. As a fixed-question format, it relies on the same question set for every respondent with no adaptive follow-up.

優れている点

  • Purpose-built for the post-visit patient feedback use case
  • Backed by SurveyMonkey's mature survey distribution and analytics platform
  • Likely quick to deploy with minimal setup for standard satisfaction tracking

物足りない点

  • Static question set with no adaptive AI probing to explore individual patient experiences further
  • No voice or conversational AI interview option to capture nuanced verbal feedback
  • No published methodology or prompt transparency for how questions were designed or scored

よくあるご質問

「Post-Visit Patient Support & Education Experience 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, and thank you for participating. This brief survey (approximately 10 minutes) asks about your most recent healt…」・「When was your most recent healthcare visit?」・「How easy was it to reach your care team when you needed help?」。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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