Assesses patient experience across scheduling access, clinician communication, post-visit follow-up, and overall satisfaction to identify actionable care quality improvements.
What's Included
AI-Powered Questions
Intelligent follow-up questions based on responses
Automated Analysis
Real-time sentiment and insight detection
Smart Distribution
Target the right audience automatically
Detailed Reports
Comprehensive insights and recommendations
Template Overview
22
Questions
AI-Powered
Smart Analysis
Ready-to-Use
Launch in Minutes
This professionally designed survey template helps you gather valuable insights with intelligent question flow and automated analysis.
Sample Survey Items
Q1
Chat Message
Welcome to this patient experience survey. We are gathering feedback about a recent healthcare visit to help improve care quality.
Your participation is entirely voluntary, and you may stop at any time. There are no right or wrong answers—we are interested in your honest opinions. All responses are confidential and will be reported only in aggregate.
This survey takes approximately 5–7 minutes to complete.
Q2
Multiple Choice
What type of visit is this feedback about?
Primary care
Specialist
Urgent care
Telehealth / video visit
Nurse-only visit
Emergency department
Other
Q3
Dropdown
When did this visit take place?
Within the past 7 days
8–30 days ago
31–90 days ago
3–12 months ago
More than a year ago
Q4
Opinion Scale
How easy was it to reach the clinic to schedule your visit or ask a question?
Range: 1 – 7
Min: Very difficultMid: NeutralMax: Very easy
Q5
Multiple Choice
How did you contact the clinic before or after your visit? Select all that apply.
Phone call
Patient portal / online message
Email
Clinic website form
Mobile app
Text / SMS
Walk-in
Did not contact the clinic
Other
Q6
Chat Message
The following questions ask about the clinician you saw during this visit. Please indicate how much you agree or disagree with each statement.
How clear were the next steps you were given after your visit (e.g., medications, tests, or self-care instructions)?
Range: 1 – 7
Min: Not at all clearMid: NeutralMax: Extremely clear
Q13
Multiple Choice
Which of the following did you receive after your visit? Select all that apply.
Written after-visit summary
Instructions via patient portal or message
A follow-up appointment or plan
Contact information for questions
Medication instructions
Test results within the expected timeframe
I did not need any follow-up
I am still waiting for follow-up information
Q14
Rating
Overall, how would you rate your experience with this visit?
Scale: 5 (star)
Min: Very poorMax: Excellent
Q15
Opinion Scale
How likely are you to recommend this clinic to a friend or family member?
Range: 0 – 10
Min: Not at all likelyMid: NeutralMax: Extremely likely
Q16
Long Text
Based on your responses, is there anything else you would like to share about your visit experience?
Max chars
Q17
AI Interview
Thank you for your responses so far. To help us better understand your experience, an AI moderator will ask a couple of brief follow-up questions.
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 5
Q18
Dropdown
What is your age?
18–24
25–34
35–44
45–54
55–64
65 or older
Prefer not to say
Q19
Multiple Choice
What is your gender identity?
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Q20
Dropdown
What is the highest level of education you have completed?
Less than high school
High school or equivalent
Some college / Associate degree
Bachelor's degree
Postgraduate degree
Prefer not to say
Q21
Dropdown
What is your current employment status?
Employed full-time
Employed part-time
Self-employed
Student
Unemployed
Retired
Not working for pay
Prefer not to say
Q22
Chat Message
Thank you for completing this survey. Your feedback is valuable and will be used to improve the care experience for all patients.
Frequently Asked Questions
What is QuestionPunk?
QuestionPunk is an AI-powered survey and research platform that turns traditional surveys into adaptive conversations. Describe your research goal and get a complete survey draft, conduct AI-moderated interviews with dynamic follow-ups, detect low-quality responses, and produce insights automatically. It's fast, flexible, and scalable across qualitative and quantitative research.
How do I create my first survey?
Sign up, then choose how to build: describe your research goal and let AI generate a survey, pick a template, or start from scratch. Add question types, set logic, preview, and share.
Can the AI generate a survey from a prompt?
Yes. Describe your research goal in plain language and QuestionPunk drafts a complete survey with appropriate question types, ordering, and AI follow-up logic. You can then customize before publishing.
What question types are available?
QuestionPunk supports a wide range of question types: opinion scale, rating, multiple choice, dropdown, ranking, matrix, constant sum, AI interview (text and audio), long text, short text, email, phone, date, address, website, numeric, audio/video recording, contact form, chat message, conversation reset, button, page breaks, and more.
How do AI interviews work?
AI interviews conduct adaptive conversations with respondents. The AI asks follow-up questions based on what the respondent says, probing for clarity and depth. You control the personality, tone, model (Haiku, Sonnet, or Opus), and question mode (fixed count, AI decides when to stop, or time-based).
Can I test my survey before launching?
Yes. Use synthetic testing to create AI personas and run them through your survey. This helps catch issues with question flow, logic, and wording before real respondents see it.
How many languages are supported?
QuestionPunk supports 142+ languages. Add languages from the survey editor, auto-translate questions, and share language-specific links. AI interviews also adapt to the respondent's language automatically.
How can I share my survey?
Share via a direct link (with optional custom slug), embed on your website (iframe or script), distribute through Prolific for research panels, or generate a QR code for physical distribution.
Can I export survey results?
Yes. Export as CSV (flat or wide layout), Excel (XLSX), or export the survey structure as PDF/Word. Filter by suspicious level, response type, language, or date range before exporting.
Does QuestionPunk detect fraudulent responses?
Yes. Every response is automatically classified with a suspicious level (low/medium/high) based on attention checks, response timing, and behavioral signals. You can filter flagged responses in the Responses tab.
What are the pricing plans?
Basic (Free): 20 responses/month. Business ($50/month or $500/year): 5,000 responses/month with priority support. Enterprise (Custom): unlimited responses, remove branding, custom domain, and dedicated support.
How long does support take to reply?
We reply within 24 hours, often much sooner. Include key details in your message to help us assist you faster.