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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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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 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
객관식필수

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
객관식필수

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
의견 척도필수

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

척도: 1 – 7
최소:Very difficult최대:Very easy
Q05
객관식

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
매트릭스필수

Rate each part of the registration process.

4개 행 × 5개 열
  • Finding an available appointment slot
  • Entering personal or insurance information
  • Receiving a confirmation message
  • Getting reminders before the appointment
열: Very poor · Poor · Fair · Good · Very good
Q07
객관식

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
의견 척도필수

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

척도: 0 – 10
최소:Not at all likely최대:Extremely likely
Q09
AI 인터뷰

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
장문형

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

Q11
객관식

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
객관식

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
메시지

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.

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

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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

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