Q01
Long Text
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Prior Authorization Patient Experience Survey
Measures patients' experiences with insurance prior authorization, capturing process clarity, wait times, care impacts, and pain points to identify systemic improvement opportunities.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
22 questions · ~4 min
Q02
Multiple Choice
Have you ever needed prior authorization (pre-approval from your health insurance) for medical care or medication?
Q03
Multiple Choice
Who primarily handled your most recent prior authorization request?
Q04
Multiple Choice
Approximately how long did it take from when the prior authorization was submitted to when a decision was made?
Q05
Long Text
To what extent did the prior authorization process delay your care or treatment?
Q06
Long Text
Rank the following aspects of prior authorization from most frustrating (top) to least frustrating (bottom).
Q07
Long Text
If you could change one thing about the prior authorization process, what would it be?
Q08
Multiple Choice
What type of health insurance do you currently have?
Q09
Long Text
Thank you for completing this survey. Your responses are confidential and will be used to help identify ways to improve the prior authorization experience for patients. If you have questions about this research, please contact the study team at the email provided in your invitation.
Q10
Multiple Choice
Which types of services or treatments required prior authorization? Select all that apply.
Q11
Multiple Choice
Which communication channels were used during your most recent prior authorization process? Select all that apply.
Q12
Multiple Choice
Approximately how many total hours did you (or a caregiver) spend on your most recent prior authorization (e.g., phone calls, paperwork, follow-ups)?
Q13
Long Text
To what extent did the prior authorization process cause you emotional stress or anxiety?
Q14
Multiple Choice
Which of the following, if any, were helpful during your prior authorization process? Select all that apply.
Q15
AI Interview
Based on your survey responses, we'd like to understand more about your prior authorization experience. What was the single most challenging part of the process for you?
Q16
Long Text
What is your age?
Q17
Multiple Choice
What was the outcome of your most recent prior authorization request?
Q18
Long Text
To what extent did the prior authorization process create a financial burden for you (e.g., unexpected costs, lost wages)?
Q19
Multiple Choice
How do you describe your gender?
Q20
Long Text
Overall, how clear was the prior authorization process (what was required of you and what steps to follow)?
Q21
Long Text
To what extent did the prior authorization process disrupt your daily activities or responsibilities?
Q22
Long Text
What is the highest level of education you have completed?
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.