Q01
メッセージ
すべてのテンプレートHealthcare & Clinical
Veterinary Patient Intake & Symptom Screening Survey
A short pre-visit intake for veterinary clinics that captures pet basics, visit reason, and recent symptom changes before the appointment, with an AI follow-up that reconstructs the timeline and severity of the primary concern so the vet walks in prepared instead of starting from scratch.
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
Q02
自由回答（短文）必須
What is your pet's name?
Q03
選択式必須
What type of animal is your pet?
- Dog
- Cat
- Bird
- Rabbit
- Reptile
Q04
自由回答（短文）
What breed is your pet, if known?
Q05
数値必須
How old is your pet, in years? Enter 0 if under one year old.
Q06
選択式必須
Is this an existing patient at our clinic, or is your pet visiting us for the first time?
- Existing patient
- First-time patient
Q07
選択式必須
What is the main reason for today's visit?
- Wellness or annual checkup
- Vaccination
- Illness or injury
- Follow-up on an existing condition
- Behavioral concern
Q08
選択式必須
In the last 7 days, has your pet had any change in appetite or thirst?
- No change
- Eating or drinking more than usual
- Eating or drinking less than usual
- Not eating or drinking at all
Q09
評価スケール必須
How would you rate your pet's energy level over the last few days compared to normal?
範囲: 1 – 5
最小:Much lower than normal最大:Much higher than normal
Q10
自由回答（長文）
List any medications, supplements, or treatments your pet is currently receiving (or write 'None').
Q11
AIインタビュー
Reconstruct the timeline of the primary concern for this visit, anchoring on the reason selected above: when it started, how it has changed (better, worse, or the same), what the owner has already tried, and how it's affecting the pet's daily behavior. If the visit reason is a routine wellness checkup, instead probe for any subtle changes the owner noticed but didn't think worth flagging (limping, scratching, mood, sleep). If the owner reports appetite or energy changes, get specifics on severity and duration rather than accepting vague descriptions.
Q12
メールアドレス
Best email to reach you if the clinic has a question before the appointment (optional).
Q13
メッセージ
Thank you! This information goes straight to your vet's team so they can prepare for your pet's visit and make the best use of your appointment time.
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 static intake fields with an AI follow-up interview that reconstructs the timeline and severity of the primary concern, so the vet has context instead of a blank slate.
- Captures the essentials fast — pet basics, new vs. existing patient status, visit reason, appetite/thirst changes, and energy-level rating — without turning the intake into a long form.
- Includes a dedicated field for current medications/supplements/treatments, directly useful for clinical prep, plus an optional email for pre-appointment follow-up.
- Uses plain-language chat messages to set expectations and thank the owner, keeping the experience approachable for non-technical pet owners.
SurveyMonkey
Veterinarian Patient Intake TemplateThis is a ready-to-field short-form template built specifically for veterinary patient intake, so it's a direct comparable. It covers standard intake basics but is a fixed-question form rather than an adaptive interview, meaning symptom detail depends entirely on how owners self-report.
優れている点
- Purpose-built for veterinary intake rather than general healthcare
- Backed by SurveyMonkey's established survey-building and distribution tools
- Short-form design likely keeps completion time low
物足りない点
- Static question set with no adaptive follow-up to probe vague symptom answers
- No mention of AI-driven timeline/severity reconstruction of the presenting concern
- No transparent prompt methodology since it's a fixed template, not an AI interview
SurveySparrow
Veterinarian Patient Intake Survey TemplateA veterinary-specific intake template that's genuinely comparable in scope and audience. It's built around SurveySparrow's conversational form style, but the conversational tone is scripted UX, not an AI system that dynamically follows up on individual answers.
優れている点
- Veterinary-specific template with a conversational, chat-like presentation
- Part of a broader healthcare template library, suggesting reusable design patterns
- Likely mobile-friendly given SurveySparrow's conversational form focus
物足りない点
- Conversational styling is pre-scripted, not adaptive AI probing based on prior answers
- No automated per-response quality scoring or auto-generated clinical-prep report
- No voice AI interview option for owners who prefer speaking over typing
よくあるご質問
「Veterinary Patient Intake & Symptom Screening 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：「Welcome! This quick intake helps your vet prepare before your pet's appointment. It takes about 7 minutes and covers bas…」・「What is your pet's name?」・「What type of animal is your pet?」。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。
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