When was your most recent healthcare visit?
- Within the last 30 days
- 1-3 months ago
- 3-6 months ago
- 6-12 months ago
- More than 12 months ago
- I have not had a visit in the past 12 months
What type of care setting did you visit most recently?
- Primary care / family medicine
- Specialist clinic
- Hospital outpatient clinic
- Emergency or urgent care
- Telehealth/virtual visit
- Behavioral or mental health
- Other
How easy was it to reach the care team when you needed help?
Which support channels did you use to get help? Select all that apply.
- Phone call
- Patient portal messages
- Email
- Text/SMS
- In-person nurse line or walk-in
- 24/7 helpline
- Support group or peer navigator
- None of the above
- Other
The explanations about my condition and treatment were clear.
How useful were the following resources during or after your visit?
Were your questions answered in a way you could understand?
- Yes, completely
- Yes, somewhat
- No
- I did not have questions
Different providers seemed to share information effectively.
Before you left, did you have a clear plan for next steps?
- Yes, a written plan
- Yes, a verbal plan only
- Partly
- No
- Not applicable
Approximately how many days passed between a referral and the appointment you most recently attended? Enter 0 if not applicable.
How confident are you in managing your health after the visit?
How likely are you to recommend this clinic or care team to a friend or family member?
What went particularly well during your most recent visit?
Max 100 chars
Attention check: To confirm you are paying attention, please select "Yes".
Which best describes your gender?
- Woman
- Man
- Non-binary
- Another identity
- Prefer not to say
What is the highest level of education you have completed?
What is your current employment status?
- Employed full-time
- Employed part-time
- Self-employed
- Student
- Homemaker/caregiver
- Unemployed
- Retired
- Unable to work
- Prefer not to say
Do you live with any ongoing health conditions? Select all that apply.
- Diabetes
- Heart or circulatory condition
- Respiratory condition (e.g., asthma, COPD)
- Mental health condition
- Musculoskeletal or pain condition
- Neurological condition
- None of the above
- Other
- Prefer not to say
Welcome! This brief survey (about 5 minutes) asks about your most recent healthcare visit within the past 12 months. Please answer based on that single visit. Your responses are confidential and reported in aggregate.
Is there anything else we could improve about support, education, or care coordination?
Max 600 chars
AI Interview: 2 Follow-up Questions on Your Visit Experience
Thank you for completing the survey. Your feedback helps us improve patient care.