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Medical Clearance Process Experience Survey

Captures how patients experience the medical clearance process — for surgery, sports participation, return to work, or travel — from scheduling through receiving the final decision. An AI follow-up interview digs into the moments that created confusion or delay, giving clinics concrete detail behind satisfaction scores.

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샘플 질문

템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.

질문 13개 · 약 7분
Q01
메시지

Thanks for taking a few minutes to share your recent experience getting medical clearance. Your honest feedback helps us make the process clearer and faster for future patients. Your responses are completely confidential and anonymized. About 4-5 minutes.

Q02
객관식필수

What type of medical clearance did you most recently go through?

  • Pre-surgical clearance
  • Sports or athletic participation clearance
  • Return-to-work clearance
  • Travel or immigration clearance
  • Clearance for a procedure or treatment
  • Other
Q03
의견 척도필수

Before your appointment, how clear were you on what documents, tests, or steps the clearance would require?

척도: 1 – 7
최소:Not clear at all최대:Extremely clear
Q04
평점 척도필수

How easy was it to schedule your clearance appointment?

범위: 1 – 5
최소:Very difficult최대:Very easy
Q05
매트릭스필수

Thinking about the clearance visit itself, how much do you agree with each statement?

4개 행 × 5개 열
  • The provider explained my results in terms I understood
  • Staff answered my questions thoroughly
  • I was told a clear timeline for when I'd get the final decision
  • I felt the clearance decision was based on a thorough evaluation
열: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q06
객관식필수

From your first appointment to receiving the final clearance decision, how long did the whole process take?

  • Same day
  • 2-3 days
  • About a week
  • 2-3 weeks
  • Longer than 3 weeks
  • Still waiting
Q07
객관식

Did any of the following slow down or complicate your clearance? Select all that apply.

  • Scheduling delays
  • Missing paperwork or records
  • Needing additional tests
  • Unclear instructions
  • Insurance or billing issues
  • Difficulty reaching the office for updates
  • None of these
Q08
의견 척도필수

How confident are you that the final clearance decision was the right one for your situation?

척도: 1 – 10
최소:Not at all confident최대:Completely confident
Q09
AI 인터뷰

Reconstruct the specific moment in this respondent's clearance journey that most shaped their confidence and timeline ratings — for example a delay, an unclear explanation, or an unexpected extra test. Ask what happened, how it was (or wasn't) resolved, and what the office could have done differently. If they reported low confidence in the decision, probe exactly what left them unsure; if they reported a smooth, fast process, ask what specifically made it work well so it can be repeated.

Q10
의견 척도필수

How likely are you to recommend this clinic or provider to someone who needs a similar clearance?

척도: 0 – 10
최소:Not at all likely최대:Extremely likely
Q11
객관식

What is your age range?

  • Under 18
  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65 or older
  • Prefer not to say
Q12
객관식

What is your gender?

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

That's everything — thank you for sharing your experience! Your responses will be used to identify where the clearance process needs to be faster and clearer for future patients.

포함된 기능

  • AI 후속 질문

    정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.

  • 주의력 확인 장치

    성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.

  • AI가 작성한 문안

    문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.

  • 자동 리포트

    응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.

다른 서비스와 비교

다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.

이 템플릿을 선택하는 이유

  • Covers the full clearance journey — scheduling, the appointment itself, and time-to-decision — across all major clearance types (surgery, sports, return to work, travel), not just one use case
  • Uses an AI follow-up interview to reconstruct the specific moment that created confusion or delay, turning a satisfaction score into a concrete, actionable story
  • Combines quantitative measures (opinion scales, ratings, a matrix of agreement statements) with open-ended AI probing, so clinics get both benchmarkable metrics and qualitative detail
  • Automated per-response quality scoring and auto-generated reports mean clinics don't have to manually read every transcript to find the friction points

Jotform

Medical Clearance Form Template

This is a static, fillable clearance form intended to document a patient's fitness-for-activity sign-off (e.g., for a physician to complete), not a survey measuring the patient's experience of the clearance process. It's a documentation tool rather than a fielding-ready experience/satisfaction survey.

잘하는 점

  • Simple, familiar drag-and-drop form builder for quickly producing a clearance document
  • Widely used template library across many healthcare form types
  • Easy to distribute and collect signatures/uploads for clearance paperwork

아쉬운 점

  • A static form with fixed fields — no adaptive follow-up questioning to explore why a delay or confusion happened
  • No mechanism to probe the specific moment in a patient's journey that caused friction
  • No automated quality scoring or synthesized reporting on patient experience themes

SurveySparrow

Free Printable Medical Clearance Form Template For Surgery

A printable clearance form scoped specifically to surgery, designed to document clearance decisions rather than survey patients about their experience going through the process. It's positioned as a free, printable asset, not an interactive experience-tracking survey.

잘하는 점

  • Free and easy to access/print
  • Purpose-built for the surgical clearance use case
  • Simple format that's quick for staff to implement

아쉬운 점

  • Limited to surgery — doesn't cover sports, return-to-work, or travel clearance journeys
  • Static question set only; no adaptive AI interview to dig into specific delay or confusion moments
  • No per-response quality scoring or automatic report generation on patient sentiment

QuestionPro

Medical Examination Services Survey Template

A genuine patient-facing survey template around medical examination services, making it a closer comparison than the two form templates above, though it's framed broadly around exam services rather than the specific clearance-decision journey (scheduling through final decision). It appears to be a standard fixed-question survey rather than one built around any single clearance-type scenario.

잘하는 점

  • Established survey platform with broad customization and distribution options
  • Covers general medical examination service satisfaction, which overlaps with parts of the clearance experience
  • Comes with reporting/analytics tooling typical of QuestionPro's platform

아쉬운 점

  • No adaptive AI follow-up interview to reconstruct the specific moment that caused delay or confusion
  • Not scoped to the clearance decision journey specifically (scheduling → appointment → final decision) across surgery/sports/work/travel contexts
  • No transparent, per-response AI quality scoring of open-ended feedback

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