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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.

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.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q6
Opinion Scale
Staff responded promptly when I reported pain.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q7
Opinion Scale
My pain was well controlled during this visit.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q8
Multiple Choice
Which methods were used to manage your pain? Select all that apply.
  • Oral medication
  • IV or injection medication
  • Ice or heat
  • Positioning or movement
  • Relaxation or breathing techniques
  • Other (please specify)
  • None of the above
Q9
Opinion Scale
How well did healthcare staff listen to your concerns during this visit?
Range: 1 7
Min: Not at all wellMid: NeutralMax: Extremely well
Q10
Opinion Scale
How clear was the information you received about your condition or treatment plan?
Range: 1 7
Min: Not at all clearMid: NeutralMax: Extremely clear
Q11
Multiple Choice
Did healthcare staff give you enough time to ask questions?
  • Yes, definitely
  • Yes, somewhat
  • No
Q12
Opinion Scale
Before I left, I clearly understood my discharge or after-visit instructions.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q13
Opinion Scale
I understood what medications to take and when to take them.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q14
Opinion Scale
I knew what warning signs or symptoms to watch for after leaving.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q15
Opinion Scale
I knew who to contact if I had questions or concerns after leaving.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q16
Opinion Scale
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

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