Patient Visit Experience: Pain, Communication & Discharge
Measures patient satisfaction across pain management, provider communication, and discharge preparedness for inpatient, outpatient, emergency, and telehealth visits.
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
25
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 collecting feedback to improve the quality of care at our facility.
This survey is voluntary and you may stop at any time. There are no right or wrong answers — we are interested in your honest opinions. Your responses are confidential and will be reported only in aggregate.
The survey takes approximately 5–7 minutes to complete. Thank you for your time.
Q2
Dropdown
When was your most recent healthcare visit?
In the last 7 days
8–14 days ago
15–30 days ago
1–3 months ago
More than 3 months ago
Q3
Multiple Choice
What type of healthcare visit was it?
Emergency department
Inpatient hospital stay (overnight)
Outpatient clinic or urgent care
Telehealth / virtual visit
Other (please specify)
Q4
Multiple Choice
Did you experience pain during this visit?
Yes
No
Q5
Opinion Scale
Healthcare staff took my pain seriously during this visit.
How confident did you feel managing your health after leaving?
Range: 1 – 7
Min: Not at all confidentMid: NeutralMax: Extremely confident
Q17
Multiple Choice
Which of the following supports did you receive before leaving? Select all that apply.
Written instructions provided
Demonstration or teach-back used
Follow-up appointment scheduled
Prescription(s) arranged before leaving
Transportation support provided
Home care or community support arranged
None of the above
Not applicable
Q18
Opinion Scale
Overall, how would you rate the quality of care you received during this visit?
Range: 1 – 7
Min: Very poorMid: NeutralMax: Excellent
Q19
Opinion Scale
How likely are you to recommend this healthcare facility to a friend or family member?
Range: 1 – 7
Min: Not at all likelyMid: NeutralMax: Extremely likely
Q20
Long Text
Based on your responses in this survey, please share any additional thoughts or feelings about your visit experience.
Max chars
Q21
AI Interview
Thank you for your written feedback. We'd like to ask a couple of brief follow-up questions to better understand your experience.
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 5
Q22
Dropdown
What is your age group?
18–24
25–34
35–44
45–54
55–64
65–74
75 or older
Prefer not to say
Q23
Multiple Choice
How do you describe your gender? Select all that apply.
Woman
Man
Non-binary
Another gender identity
Prefer not to say
Q24
Dropdown
What is your current employment status?
Employed full-time
Employed part-time
Self-employed
Unemployed
Student
Retired
Unable to work
Prefer not to say
Q25
Chat Message
Thank you for completing this survey. Your feedback helps us improve the quality of care we provide. Your responses are confidential and will be reviewed in aggregate.
If you have an urgent medical concern, please contact your healthcare provider directly.
Frequently Asked Questions
What is QuestionPunk?
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