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
Template Overview
24
Questions
AI-Powered
Smart Analysis
Ready-to-Use
Launch in Minutes
This professionally designed survey template helps you gather valuable insights with intelligent question flow and automated analysis.
Sample Survey Items
Q1
Dropdown
When was your most recent oncology appointment?
Within the last 30 days
31–90 days ago
3–6 months ago
6–12 months ago
More than 12 months ago
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?
Scale: 11 (star)
Min: Very difficultMax: Very easy
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?
Range: 1 – 10
Min: Very difficultMid: NeutralMax: Very easy
Q6
Numeric
About how many days were there between scheduling and that appointment? If same-day, enter 0.
Accepts a numeric value
Whole numbers only
Q7
Ranking
Rank the barriers that made arranging care difficult in the last 3 months (top = biggest barrier). If none applied, leave blank.
Drag to order (top = most important)
Finding available appointment times
Getting insurance approval/authorizations
Travel/transportation or parking
Cost or co-pays
Work or caregiving conflicts
Not knowing whom to contact
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?
Rows
Strongly disagree
Disagree
Neither
Agree
Strongly agree
My care team shared information so I did not need to repeat my history
•
•
•
•
•
I knew who to contact with questions between visits
•
•
•
•
•
Test results were communicated promptly
•
•
•
•
•
Different specialists were aligned on my treatment plan
•
•
•
•
•
I received clear follow-up instructions
•
•
•
•
•
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?
Scale: 11 (star)
Min: Not helpfulMax: Extremely helpful
Q14
Opinion Scale
In the last 3 months, how clear was the information you received about your treatment options?
Range: 1 – 10
Min: Very unclearMid: NeutralMax: Very clear
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?
18–24
25–34
35–44
45–54
55–64
65–74
75 or older
Prefer not to say
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?
Less than high school
High school diploma or equivalent
Some college or 2-year degree
Bachelor’s degree
Graduate or professional degree
Prefer not to say
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 InterviewLength: 2Personality: [Object Object]Mode: Fast
Q24
Chat Message
Thank you for completing the survey. Your feedback helps us improve oncology care access, scheduling, and coordination.
Frequently Asked Questions
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