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Patient Portal Lab Results Survey Template

Use this template to gather feedback on how patients interpret lab results and reference ranges in patient portals. Improve clarity and satisfaction. 6–8 min.

What's Included

AI-Powered Questions

Intelligent follow-up questions based on responses

Automated Analysis

Real-time sentiment and insight detection

Smart Distribution

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Detailed Reports

Comprehensive insights and recommendations

Sample Survey Items

Q1
multiple choice
In the past 12 months, how often have you viewed lab results in an online portal?
  • Several times a month
  • About once a month
  • Every few months
  • Once in the last year
  • Not in the last 12 months
Q2
multiple choice
In the past 12 months, where did you view lab results online? Select all that apply.
  • Hospital or health system portal
  • Primary care clinic portal
  • Lab company portal (e.g., a national lab)
  • Insurance portal
  • Emailed PDF or attachment
  • I haven’t viewed lab results online in the last 12 months
Q3
rating
Overall, how confident are you in understanding your lab results when viewing them online?
Q4
multiple choice
If your ALT (alanine aminotransferase) result is 45 U/L and the portal shows a reference range of 7–55 U/L, what does this most likely mean?
  • Your result is within the reference range
  • Your result is dangerously high
  • Your result is dangerously low
  • It depends; more clinical context is needed
  • Not sure
Q5
matrix
Thinking about portals you used in the last 12 months, how much do you agree with the following?
Q6
multiple choice
In the last 12 months, have units (e.g., mg/dL vs mmol/L) ever made a result hard to understand?
  • Yes
  • No
  • Not applicable
Q7
multiple choice
Attention check: To confirm you’re paying attention, please select “Blue” below.
  • Red
  • Green
  • Blue
  • Yellow
Q8
ranking
Rank the features that would most help you understand your lab results (top = most helpful).
Q9
multiple choice
When you see an out-of-range result online, what do you usually do first? Select all that apply.
  • Send a message to my clinician
  • Schedule an appointment
  • Search online for information
  • Wait for a clinician note or call
  • Ignore if only slightly out of range
  • I have not had an out-of-range result
Q10
long text
Briefly describe a time in the last 12 months when a lab result was confusing and what would have helped.
Max 600 chars
Q11
dropdown
What is your age?
Q12
multiple choice
Which best describes your gender?
  • Woman
  • Man
  • Non-binary
  • Prefer not to say
Q13
short text
Which country do you live in?
Max 100 chars
Q14
multiple choice
What is the highest level of education you have completed?
  • Less than high school
  • High school or equivalent
  • Some college or vocational training
  • Bachelor’s degree
  • Graduate or professional degree
  • Prefer not to say
Q15
multiple choice
What is your current employment status?
  • Employed full-time
  • Employed part-time
  • Self-employed
  • Student
  • Homemaker or caregiver
  • Retired
  • Unemployed
  • Unable to work
  • Prefer not to say
Q16
chat message
Welcome! This brief survey asks about how you view and interpret lab results in online portals. Please answer based on your experience in the last 12 months.
Q17
long text
Any additional comments about this survey or about viewing lab results in portals?
Max 600 chars
Q18
ai interview
AI Interview: 2 Follow-up Questions on lab results and portals
AI Interview
Q19
chat message
Thank you for participating—your feedback helps improve how lab results are shared and explained. You may close the survey now.

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Patient Portal Lab Results Survey Template - Survey Template | QuestionPunk