Medical Examination & Check-Up Experience Survey

Thanks for taking a few minutes to share feedback on your recent medical exam or check-up. Your responses are completely confidential and anonymized. Your honest answers help the clinic improve patient care. This should take about 5 minutes.

Which best describes the exam or check-up you recently had?

• Annual physical / general check-up
• Specialist diagnostic exam (e.g., imaging, cardiac, women's/men's health)
• Preventive screening (e.g., blood work, cancer screening)
• Pre-employment or insurance-required exam
• Follow-up exam for an existing condition
• Other

How easy was it to schedule this appointment?

How would you rate the friendliness and helpfulness of the front-desk / check-in staff?

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

How likely are you to recommend this clinic for a similar exam to a friend or family member?

If the clinic could only improve a few things, which of these matter most to you, and which matter least?

• Shorter wait times
• Lower out-of-pocket cost
• Clearer explanation of results
• Friendlier staff
• Cleaner, more comfortable facility
• Easier online scheduling
• Faster follow-up after the visit

Reconstruct exactly what happened when the respondent's results were shared with them: who explained them, what was said, whether they understood next steps, and whether anything was left unclear or worrying. If they gave a low recommend score, probe for the single most negative moment of the visit and what would have fixed it in the moment; if high, probe what specifically stood out as exceptional.

Is there anything else about your exam experience — good or bad — you'd like the clinic to know?

What is your age range? (optional)

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

What is your gender? (optional)

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

Thank you for sharing your experience! Your responses will be reviewed by the clinic's patient experience team to improve scheduling, communication, and overall care quality.