すべてのテンプレート
Healthcare & Clinical

Teletherapy From Home Continuation Preferences

Measures whether clients want to keep doing therapy from home by video or phone, shift to a hybrid model, or return to in-person care — and why. Built for behavioral health practices and telehealth platforms deciding how to structure ongoing care; the AI follow-up interview digs into the specific trade-offs, like privacy and connection with the therapist, behind each person's stated preference.

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14問・約7分
Q01
メッセージ

Thanks for taking a few minutes to share your experience with therapy sessions from home. This helps your care team figure out what should continue, change, or move back in-person. About 8 minutes, and your individual answers stay confidential.

Q02
選択式必須

In the last 3 months, how have you mainly received your therapy or counseling sessions?

  • Entirely video sessions from home
  • Entirely phone sessions from home
  • A mix of from-home and in-person sessions
  • Entirely in-person sessions
Q03
数値

In the last 3 months, roughly how many therapy sessions have you had by video or phone from home?

Q04
オピニオンスケール必須

Overall, how satisfied are you with doing therapy by video or phone from home?

スケール: 1 – 7
最小:Not at all satisfied最大:Extremely satisfied
Q05
マトリクス必須

How much do you agree with each statement about attending therapy from home?

5行 × 5列
  • I can speak openly and privately during my video/phone sessions
  • Video/phone sessions are easier to fit into my schedule
  • I feel as connected to my therapist by video/phone as I would in person
  • The technology (video, audio, connection) works reliably for my sessions
  • Sessions from home cost me less time or money (travel, childcare, time off work)
列: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q06
評価スケール

How easy is it to schedule and join your video or phone sessions?

範囲: 1 – 5
最小:Very difficult最大:Very easy
Q07
ベスト・ワースト選択(MaxDiff)

Which of these matter most, and least, in deciding how you'd like to attend therapy?

  • Not having to travel to an office
  • Being in a comfortable, familiar space
  • More privacy than a waiting room
  • Easier to fit around work or childcare
  • Feeling less connected to my therapist
  • Technical problems during sessions
  • Harder to focus or avoid distractions at home
各セットで最も良いもの・最も悪いものを選択最も良い:Matters most to my preference最も悪い:Matters least to my preference
Q08
選択式必須

Going forward, how would you prefer to attend your therapy sessions?

  • Continue entirely from home (video or phone)
  • A mix of from-home and in-person sessions
  • Return to entirely in-person sessions
  • No strong preference either way
Q09
選択式

Which of the following have gotten in the way of your video or phone sessions?

  • Unreliable internet or phone connection
  • Lack of privacy at home
  • Hard to find a quiet, uninterrupted space
  • Scheduling conflicts
  • Feeling disconnected from my therapist
  • Difficulty using the video platform
Q10
AIインタビュー

Anchor on the respondent's stated future preference (continue from home, hybrid, in-person, or no preference) and reconstruct the specific reasoning behind it — what a typical from-home session feels like for them, and what would need to change for them to switch formats. If they chose hybrid or 'no preference', probe which situations push them toward video/phone versus in-person. If they reported feeling less connected to their therapist, dig into whether that's about the format itself or the specific therapist relationship.

Q11
選択式

What is your age range? (optional)

  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65+
  • Prefer not to say
Q12
選択式

What is your gender? (optional)

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q13
選択式

How do you mainly pay for these therapy sessions? (optional)

  • Private/employer health insurance
  • Public or government insurance
  • Out of pocket
  • Employee assistance program
  • Prefer not to say
Q14
メッセージ

Thank you for sharing your experience — this feedback directly shapes whether we keep offering flexible from-home sessions, expand in-person options, or build a hybrid model. Your responses are combined with others' and kept confidential.

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。

このテンプレートを選ぶ理由

このテンプレートの設計意図をご紹介します。ほかのアンケートツールには、直接比較できるテンプレートが見つかりませんでした。

ここが違う

  • Includes a matrix and opinion-scale set that captures satisfaction, ease of scheduling, and agreement with specific home-therapy statements in one structured pass
  • Uses a max-diff question to force trade-off prioritization (e.g., privacy vs. connection with therapist) rather than relying on a single ranked list
  • Pairs a direct multiple-choice preference question (continue from home, hybrid, in-person) with an AI follow-up interview that adapts its probing to that stated preference, digging into the specific trade-offs behind it
  • Captures practical barriers (what's gotten in the way of video/phone sessions) alongside payment method and demographics, giving practices context for why preferences differ across client segments

よくあるご質問

「Teletherapy From Home Continuation Preferences」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14問含まれており、最初の設問は次のとおりです:「Thanks for taking a few minutes to share your experience with therapy sessions from home. This helps your care team figu…」・「In the last 3 months, how have you mainly received your therapy or counseling sessions?」・「In the last 3 months, roughly how many therapy sessions have you had by video or phone from home?」。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、14問を約7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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