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Oncology Patient Experience Survey Template

Measure access to oncology care, appointment scheduling, patient navigation, and care coordination. Ready-to-use, customizable template; 7–10 minutes.

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

Sample Survey Items

Q1
dropdown
When was your most recent oncology appointment?
Q2
multiple choice
In the last 6 months, which types of oncology care did you use? Select all that apply.
  • Medical oncologist
  • Radiation oncologist
  • Surgical oncologist
  • Infusion/chemotherapy center
  • Imaging/radiology
  • Survivorship/after-treatment clinic
  • Palliative care
  • None of the above
Q3
rating
Overall, how easy has it been to access the oncology care you needed in the last 3 months?
Q4
multiple choice
How did you schedule your most recent oncology appointment?
  • Phone call to clinic
  • Patient portal/online
  • In person at the clinic
  • Referral arranged by another office
  • Someone else scheduled for me
Q5
opinion scale
For your most recent appointment, how easy was it to get a convenient date and time?
Q6
numeric
About how many days were there between scheduling and that appointment? If same-day, enter 0.
Q7
ranking
Rank the barriers that made arranging care difficult in the last 3 months (top = biggest barrier). If none applied, leave blank.
Q8
multiple choice
Attention check: To confirm you are reading the questions, please select Agree.
  • Strongly disagree
  • Disagree
  • Neither
  • Agree
  • Strongly agree
Q9
matrix
In the last 3 months, to what extent do you agree or disagree with the following statements?
Q10
multiple choice
Is there one person who helps coordinate your oncology care across providers?
  • Yes
  • No
  • Not sure
Q11
multiple choice
After your most recent visit, did you receive a written or electronic care plan with next steps?
  • Yes
  • No
  • Not sure
Q12
multiple choice
In the last 6 months, which navigation or support services did you use? Select all that apply.
  • Nurse navigator
  • Care coordinator
  • Social worker
  • Financial counselor
  • Transportation assistance
  • Language interpreter
  • Education classes/materials
  • Did not use any of these
Q13
rating
If you used any navigation or support services, how helpful were they overall?
Q14
opinion scale
In the last 3 months, how clear was the information you received about your treatment options?
Q15
multiple choice
In the last 3 months, which ways did your care team communicate with you between visits? Select all that apply.
  • Phone calls
  • Patient portal messages
  • Email
  • Text/SMS
  • Video visit/telehealth
  • Printed letters
  • No contact between visits
Q16
dropdown
What is your age?
Q17
multiple choice
Which best describes your gender?
  • Woman
  • Man
  • Non-binary
  • Prefer not to say
Q18
short text
Country of residence
Max 100 chars
Q19
dropdown
What is the highest level of education you have completed?
Q20
multiple choice
What is your current employment status?
  • Employed full-time
  • Employed part-time
  • Self-employed
  • Unemployed and looking for work
  • Student
  • Retired
  • Homemaker/caregiver
  • Unable to work
  • Prefer not to say
Q21
multiple choice
Which racial or ethnic groups do you identify with? Select all that apply.
  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Hispanic or Latino/a/x
  • Middle Eastern or North African
  • Native Hawaiian or Pacific Islander
  • White
  • Another group
  • Prefer not to say
Q22
long text
What could we improve to make navigating and coordinating your care easier?
Max 600 chars
Q23
ai interview
AI Interview: 2 Follow-up Questions on your care experience
AI Interview
Q24
chat message
Thank you for completing the survey. Your feedback helps us improve oncology care access, scheduling, and coordination.

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Oncology Patient Experience Survey Template - Survey Template | QuestionPunk