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 a lightweight survey platform for live AI interviews you control. It's fast, flexible, and scalable—adapting every question in real time, moderating responses across languages, letting you steer prompts, models, and flows, and even generating surveys from a simple prompt. Get interview-grade insight with survey-level speed across qual and quant.
How do I create my first survey?
Sign up, then decide how you want to build: let the AI generate a survey from your prompt, pick a template, or start from scratch. Choose question types, set logic, and preview before sharing.
How can I share surveys with my team?
Send a project link so teammates can view and collaborate instantly.
Can the AI generate a survey from a prompt?
Yes. Provide a prompt and QuestionPunk drafts a survey you can tweak before sending.
How long does support typically take to reply?
We reply within 24 hours—often much sooner. Include key details in your message to help us assist you faster.
Can I export survey results?
Absolutely. Export results as CSV straight from the results page for quick data work.