Q01
Long Text
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Patient Experience Survey: Access, Communication & Care Quality
Measures patient satisfaction across appointment access, provider communication, follow-up timeliness, and digital touchpoints for healthcare organizations seeking actionable improvement insights and NPS benchmarking.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
23 questions · ~4 min
Q02
Long Text
When was your most recent visit or interaction with us?
Q03
Multiple Choice
How did you schedule or start that visit?
Q04
Long Text
We'd like to understand your communication experience with your provider. Please indicate how much you agree or disagree with each statement.
Q05
Multiple Choice
After your visit, did you receive follow-up information or results?
Q06
Multiple Choice
Which of the following digital features, if any, did you use for this visit? Select all that apply.
Q07
Long Text
Based on your experience, what is one thing we could improve for patients like you?
Q08
Multiple Choice
What is your age group?
Q09
Long Text
Thank you for your feedback—your responses will help us improve care for patients like you.
Q10
Multiple Choice
What type of care did you receive most recently?
Q11
Long Text
Overall, how easy was it to get the care you needed?
Q12
Long Text
My provider listened carefully to me.
Q13
Rating Scale
Overall, how would you rate your experience with the clinician you saw?
Q14
Long Text
How easy was the website or app to use for your needs?
Q15
AI Interview
We'd like to learn a bit more about your visit. An AI moderator will ask you a couple of brief follow-up questions based on your responses.
Q16
Multiple Choice
What is your gender?
Q17
Long Text
Approximately how long did you wait past your scheduled appointment time?
Q18
Long Text
My provider explained things in a way I could understand.
Q19
Long Text
My main health concern was addressed or resolved during this visit.
Q20
Long Text
In which country do you currently reside?
Q21
Long Text
My provider showed respect for what I had to say.
Q22
Long Text
How likely are you to recommend our care to a friend or family member?
Q23
Long Text
I felt involved in decisions about my care.
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.