Q01
Long Text
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Patient Visit Experience: Pain, Communication & Discharge
Measures patient satisfaction across pain management, provider communication, and discharge preparedness for inpatient, outpatient, emergency, and telehealth visits.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
25 questions · ~4 min
Q02
Long Text
When was your most recent healthcare visit?
Q03
Multiple Choice
Did you experience pain during this visit?
Q04
Long Text
How well did healthcare staff listen to your concerns during this visit?
Q05
Long Text
Before I left, I clearly understood my discharge or after-visit instructions.
Q06
Long Text
Overall, how would you rate the quality of care you received during this visit?
Q07
Long Text
What is your age group?
Q08
Long Text
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.
Q09
Multiple Choice
What type of healthcare visit was it?
Q10
Long Text
Healthcare staff took my pain seriously during this visit.
Q11
Long Text
How clear was the information you received about your condition or treatment plan?
Q12
Long Text
I understood what medications to take and when to take them.
Q13
Long Text
How likely are you to recommend this healthcare facility to a friend or family member?
Q14
Multiple Choice
How do you describe your gender? Select all that apply.
Q15
Long Text
Staff responded promptly when I reported pain.
Q16
Multiple Choice
Did healthcare staff give you enough time to ask questions?
Q17
Long Text
I knew what warning signs or symptoms to watch for after leaving.
Q18
Long Text
Based on your responses in this survey, please share any additional thoughts or feelings about your visit experience.
Q19
Long Text
What is your current employment status?
Q20
Long Text
My pain was well controlled during this visit.
Q21
Long Text
I knew who to contact if I had questions or concerns after leaving.
Q22
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.
Q23
Multiple Choice
Which methods were used to manage your pain? Select all that apply.
Q24
Long Text
How confident did you feel managing your health after leaving?
Q25
Multiple Choice
Which of the following supports did you receive before leaving? Select all that apply.
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.