Q01
Long Text
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Post-Visit Patient Experience & NPS Survey
Measures patient satisfaction across scheduling, wait times, provider interaction, and telehealth quality using NPS and multi-dimensional experience scales for healthcare organizations seeking actionable improvement insights.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
22 questions · ~4 min
Q02
Long Text
When was your most recent healthcare appointment?
Q03
Multiple Choice
What type of visit was your most recent appointment?
Q04
Long Text
We'd like you to think about your interaction with your provider during your most recent visit. Please indicate how much you agree or disagree with each of the following statements.
Q05
Long Text
Overall, how satisfied are you with your most recent healthcare visit?
Q06
Long Text
Finally, a few optional questions about you for analysis purposes.
Q07
Long Text
Thank you for completing this survey. Your feedback is valuable and will be used to improve the care experience for all patients.
Q08
Multiple Choice
How did you schedule that appointment?
Q09
Long Text
How satisfied were you with the wait time before your appointment began?
Q10
Long Text
My provider listened carefully to my concerns.
Q11
Long Text
How likely are you to recommend this clinic or provider to a friend or family member?
Q12
Long Text
What is your age group?
Q13
Long Text
How easy or difficult was it to schedule your appointment?
Q14
Long Text
If your visit used phone or video, how would you rate the overall technology experience (audio quality, video clarity, ease of connecting)? If your visit was in person, please skip this question.
Q15
Long Text
My provider explained things in a way I could understand.
Q16
Long Text
Please share one thing that went well and one thing that could be improved about your visit.
Q17
Multiple Choice
Which gender do you identify with?
Q18
Long Text
My provider treated me with courtesy and respect.
Q19
AI Interview
Based on your responses, we'd like to explore your visit experience a bit further. Please share your thoughts in a brief conversation.
Q20
Long Text
In which country or region do you currently live?
Q21
Long Text
My provider involved me in decisions about my care.
Q22
Long Text
How clear were your next steps (e.g., medications, tests, follow-up appointments) after the visit?
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.