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Patient Visit Experience & Care Feedback Survey

Captures how patients experienced a recent visit — wait times, communication, staff respect, and overall likelihood to recommend — with a best-worst prioritization of improvement areas and an AI follow-up that digs into the specific moment behind their recommendation score. Built for clinics, hospitals, and practice managers tracking care quality.

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샘플 질문

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

질문 12개 · 약 7분
Q01
메시지

Thanks for taking a few minutes to share feedback on your recent visit. Your honest answers help our care team improve — this should take about 4-5 minutes, and your responses are kept confidential.

Q02
의견 척도필수

How likely are you to recommend this clinic to family or friends?

척도: 0 – 10
최소:Not at all likely최대:Extremely likely
Q03
매트릭스필수

Thinking about your most recent visit, how would you rate each of the following?

5개 행 × 5개 열
  • Time spent waiting
  • Clarity of explanations from your care team
  • Friendliness and respect from staff
  • Cleanliness of the facility
  • Ease of scheduling your visit
열: Poor · Fair · Good · Very good · Excellent
Q04
객관식필수

At your last visit, how long did you wait past your scheduled appointment time before being seen?

  • Seen early or on time
  • 1-15 minutes
  • 16-30 minutes
  • 31-60 minutes
  • More than an hour
Q05
객관식필수

Did you feel you had enough time to ask questions during your visit?

  • Yes, completely
  • Somewhat
  • Not really
  • No, not at all
Q06
AI 인터뷰

Reconstruct the specific moment that shaped the respondent's recommendation score: what happened, who was involved, and whether it was about wait time, communication, or something else. Anchor on whichever matrix item they rated lowest and ask them to walk through what occurred step by step. If the score was high, probe what specifically stood out so it can be reinforced elsewhere in the practice.

Q07
객관식

Which best describes the main reason for your visit?

  • Routine checkup or physical
  • New symptom or concern
  • Follow-up on an existing condition
  • Procedure or surgery
  • Test results or lab review
Q08
최선·최악 선택형(MaxDiff)필수

If our clinic could only improve two of these, which would matter most and least to your experience?

  • Shorter wait times
  • More time with your provider
  • Clearer explanation of diagnosis or treatment
  • Better communication between visits
  • Friendlier front-desk staff
  • Easier online scheduling
  • More comfortable waiting area
  • Faster follow-up after the visit
세트별 최선·최악 선택최선:Most important to improve최악:Least important to improve
Q09
장문형

Is there anything else about your visit — good or bad — you'd like us to know?

Q10
객관식

What is your age range?

  • Under 18
  • 18-29
  • 30-44
  • 45-59
  • 60-74
  • 75+
  • Prefer not to say
Q11
객관식

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer not to say
Q12
메시지

Thank you for sharing your feedback! Your responses go directly to our care quality team and help us fix real issues in scheduling, communication, and care delivery.

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

  • Goes beyond satisfaction ratings with an AI follow-up interview that reconstructs the specific moment behind each patient's recommendation score, surfacing root causes static forms miss
  • Uses a best-worst (max-diff) prioritization exercise so clinics know exactly which improvement areas matter most versus least, not just averaged ratings
  • Combines a quantitative core (recommendation score, matrix ratings on wait time/communication/respect) with an open-ended long-text question and screening questions like visit reason and time waited, giving both breadth and depth
  • Automated per-response quality scoring and an auto-generated report mean practice managers get analysis-ready output instead of raw spreadsheet data to sort through manually

Jotform

Create Free Patient Feedback Forms - Patient Feedback Form Templates

This is a template gallery/category page offering multiple static patient feedback form layouts rather than a single fielding-ready survey. It's built for quick deployment and easy customization via Jotform's drag-and-drop builder, useful for clinics wanting a fast, no-frills intake of feedback.

잘하는 점

  • Wide selection of pre-built form layouts to choose from
  • Familiar drag-and-drop form builder for quick customization
  • Likely supports embedding on clinic websites or kiosks

아쉬운 점

  • Static form fields only — no adaptive follow-up questioning to probe why a patient rated something poorly
  • No mention of automated per-response quality scoring or auto-generated analysis reports
  • No transparent methodology for how responses are interpreted or prioritized

Typeform

Patient Feedback Form Template

A single conversational-style template focused on collecting patient feedback with Typeform's signature one-question-at-a-time UX. It's designed for a pleasant respondent experience but relies on fixed question paths rather than dynamic follow-up.

잘하는 점

  • Polished, conversational one-question-at-a-time interface likely improves completion rates
  • Easy to customize branding and question wording
  • Simple to deploy via link or embed

아쉬운 점

  • No adaptive AI interviewing — logic branching is rule-based, not a dynamic conversational probe into a specific visit moment
  • No built-in best-worst prioritization exercise for improvement areas
  • No automated quality scoring or auto-generated insights report

SurveyMonkey

Patient Satisfaction Survey Template

A dedicated post-visit patient satisfaction template covering standard experience metrics, positioned similarly to our use case. It benefits from SurveyMonkey's established analytics and benchmarking tools, but the question set appears fixed rather than adaptive.

잘하는 점

  • Purpose-built for post-visit satisfaction tracking, directly comparable in scope
  • Backed by SurveyMonkey's broader analytics dashboards and benchmarking data
  • Likely offers straightforward multi-channel distribution (email, link, embed)

아쉬운 점

  • No adaptive AI follow-up to dig into the specific moment behind a low or high recommendation score
  • No max-diff-style prioritization built into the template as described
  • No transparent per-response quality scoring mechanism mentioned

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