Q01
Long Text
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Post-Visit Patient Support & Education Experience Survey
Measures patient perceptions of post-visit support access, health education clarity, and care coordination quality. Designed for healthcare organizations seeking to identify gaps in patient communication and follow-up processes.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
22 questions · ~4 min
Q02
Multiple Choice
When was your most recent healthcare visit?
Q03
Long Text
How easy was it to reach your care team when you needed help?
Q04
Long Text
The explanations I received about my condition and treatment were clear and easy to understand.
Q05
Long Text
The different providers involved in my care seemed to share information effectively with each other.
Q06
Long Text
How confident are you in managing your health based on what you learned during your visit?
Q07
AI Interview
We'd like to understand your experience in more detail. An AI moderator will ask you a couple of brief follow-up questions about the support and education you received.
Q08
Long Text
What is your age?
Q09
Long Text
Thank you for completing this survey. Your feedback is valuable and will be used to improve patient support, education, and care coordination.
Q10
Multiple Choice
What type of care setting did you visit most recently?
Q11
Multiple Choice
Which of the following support channels did you use to get help? Select all that apply.
Q12
Multiple Choice
Were your questions answered in a way you could understand?
Q13
Multiple Choice
Before you left, did you have a clear plan for your next steps in care?
Q14
Long Text
How likely are you to recommend this clinic or care team to a friend or family member?
Q15
Long Text
What went particularly well during your most recent visit?
Q16
Multiple Choice
Which best describes your gender?
Q17
Multiple Choice
Which of the following educational resources did you find useful during or after your visit? Select all that apply.
Q18
Long Text
If you were referred to another provider, approximately how long did you wait between the referral and the appointment?
Q19
Long Text
Based on your responses in this survey, is there anything else we could improve about support, education, or care coordination?
Q20
Long Text
Where do you currently live?
Q21
Long Text
What is the highest level of education you have completed?
Q22
Multiple Choice
Do you currently live with any ongoing health conditions? 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.