Q01
Long Text
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Patient Visit Satisfaction & Communication Survey
Assesses patient experience across scheduling access, clinician communication, post-visit follow-up, and overall satisfaction to identify actionable care quality improvements.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
22 questions · ~4 min
Q02
Multiple Choice
What type of visit is this feedback about?
Q03
Long Text
How easy was it to reach the clinic to schedule your visit or ask a question?
Q04
Long Text
The following questions ask about the clinician you saw during this visit. Please indicate how much you agree or disagree with each statement.
Q05
Long Text
How clear were the next steps you were given after your visit (e.g., medications, tests, or self-care instructions)?
Q06
Rating Scale
Overall, how would you rate your experience with this visit?
Q07
Long Text
What is your age?
Q08
Long Text
Thank you for completing this survey. Your feedback is valuable and will be used to improve the care experience for all patients.
Q09
Long Text
When did this visit take place?
Q10
Multiple Choice
How did you contact the clinic before or after your visit? Select all that apply.
Q11
Long Text
The clinician listened carefully to me.
Q12
Multiple Choice
Which of the following did you receive after your visit? Select all that apply.
Q13
Long Text
How likely are you to recommend this clinic to a friend or family member?
Q14
Multiple Choice
What is your gender identity?
Q15
Long Text
The clinician explained things in a way I could understand.
Q16
Long Text
Based on your responses, is there anything else you would like to share about your visit experience?
Q17
Long Text
What is the highest level of education you have completed?
Q18
Long Text
The clinician showed respect for what I had to say.
Q19
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.
Q20
Long Text
What is your current employment status?
Q21
Long Text
The clinician spent enough time with me.
Q22
Long Text
I felt involved in decisions about my care.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.