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Industry-Specific

Vaccine Appointment Registration Experience Survey

Measures how easily people can find, register for, and confirm vaccination appointments across online, phone, and walk-in channels, and pinpoints exactly where the process breaks down. Built for health systems, pharmacies, and public health programs; the AI follow-up interview reconstructs what actually happened at the moment registration got difficult, not just a friction score.

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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13問・約7分
Q01
メッセージ

Thanks for taking a few minutes to tell us about registering for your vaccine appointment! Your honest feedback helps us make the process smoother for everyone. Your responses are completely confidential and anonymized. This will take about 7 minutes.

Q02
選択式必須

Which vaccine were you registering for? (Template note: replace these options with the vaccines your program offers.)

  • Seasonal flu shot
  • COVID-19 vaccine or booster
  • RSV vaccine
  • Childhood immunization
  • Travel vaccine
Q03
選択式必須

How did you complete your registration?

  • Online portal or website
  • Phone call
  • Walk-in without an appointment
  • Mobile app
  • Through my employer or school
  • Someone else registered for me
Q04
オピニオンスケール必須

Overall, how easy or difficult was it to register for your appointment?

スケール: 1 – 7
最小:Very difficult最大:Very easy
Q05
選択式

About how long did the registration process take, from start to confirmation?

  • Less than 5 minutes
  • 5-15 minutes
  • 16-30 minutes
  • More than 30 minutes
  • I gave up before finishing
Q06
マトリクス必須

Rate each part of the registration process.

4行 × 5列
  • Finding an available appointment slot
  • Entering personal or insurance information
  • Receiving a confirmation message
  • Getting reminders before the appointment
列: Very poor · Poor · Fair · Good · Very good
Q07
選択式

Did you run into any of these problems while registering? Select all that apply.

  • Website or app errors
  • Long wait times on hold
  • Confusing instructions
  • No appointment slots available
  • Language barriers
  • Had to re-enter information multiple times
Q08
オピニオンスケール必須

How likely are you to recommend this registration process to a friend or family member who needs a vaccine?

スケール: 0 – 10
最小:Not at all likely最大:Extremely likely
Q09
AIインタビュー

Reconstruct the specific moment the respondent's registration went smoothly or got difficult: what step they were on, what exactly happened (an error message, a hold time, confusing wording), and how they resolved it — called back, asked staff, or gave up. If they reported a problem or rated ease low, dig into what would have fixed it on the first try. If they gave up before finishing, find out whether and how they eventually got vaccinated.

Q10
自由回答（長文）

What one change would have made registering for your vaccine easier?

Q11
選択式

Which age group do you fall into?

  • Under 18
  • 18-29
  • 30-44
  • 45-59
  • 60-74
  • 75 or older
  • Prefer not to say
Q12
選択式

Which best describes why you were registering?

  • General public
  • Healthcare worker
  • High-risk or chronic condition
  • Caregiver registering for someone else
  • Employer or school-sponsored program
  • Prefer not to say
Q13
メッセージ

That's everything — thank you! Your answers will be used to fix bottlenecks in the vaccine registration process and reported back to the team running this program.

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 a dedicated opinion-scale ease rating plus a separate recommend-likelihood question, giving both a friction score and an NPS-style signal
  • A matrix question rates each individual step of the registration process (finding, registering, confirming), pinpointing exactly where breakdown occurs across online, phone, and walk-in channels
  • An AI follow-up interview reconstructs the specific moment registration went smoothly or went wrong, capturing what actually happened rather than just a satisfaction number
  • Covers channel completed, time-to-confirmation, specific problems encountered, and an open-ended 'one change' question, then closes with a transparent note on how responses will be used to fix bottlenecks

Jotform

COVID-19 Vaccine Registration Form Template

This is a data-intake form for signing people up for a vaccine appointment (name, contact info, appointment slot), not a survey measuring how the registration experience went. It's a fielding-ready form template but serves a different purpose than an experience/friction survey. Useful for the registration step itself, not for diagnosing where people struggled.

優れている点

  • Easy drag-and-drop customization within a widely used form builder
  • Broad template library and integrations for actual appointment intake
  • Free to use and quick to deploy for basic registration collection

物足りない点

  • Static field-based form with no adaptive follow-up probing into why a step failed
  • No automated per-response quality scoring or synthesized report on friction points
  • No AI or voice interview capability to reconstruct what happened at the moment of difficulty

SurveySparrow

Vaccination Registration Form Template | COVID - 19

Also framed as a registration form (collecting appointment/registration details) rather than a post-registration experience survey. SurveySparrow's conversational, chat-style format is a nice touch for completion rates, but the template itself is about capturing registration data, not diagnosing channel-specific friction. Fielding-ready as a form, not as a diagnostic experience study.

優れている点

  • Conversational, chat-like question flow that can feel friendlier than a static form
  • Supports multi-channel distribution for collecting registrations
  • Simple to launch without custom setup

物足りない点

  • No adaptive AI interviewing to dig into a specific bad moment in the registration process
  • No automated quality scoring per response or auto-generated diagnostic report
  • No published methodology or prompt transparency behind its question logic

よくあるご質問

「Vaccine Appointment Registration 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13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 tell us about registering for your vaccine appointment! Your honest feedback helps us…」・「Which vaccine were you registering for? (Template note: replace these options with the vaccines your program offers.)」・「How did you complete your registration?」。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、13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。

このテンプレートを使う無料で始める

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