Q01
Message
All templatesHealthcare & Clinical
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 · ~10 min
Q02
Dropdown
When was your most recent visit or interaction with us?
- Within the last 7 days
- 2–4 weeks ago
- 1–3 months ago
- 3–6 months ago
Q03
Multiple Choice
How did you schedule or start that visit?
- Website
- Mobile app
- Phone call
- Walk-in
- Referral link or email
- Third-party marketplace
- Other
Q04
Message
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?
- Yes, within 24 hours
- Yes, within 2–3 days
- Yes, but later than 3 days
- No follow-up was needed
- No, I expected follow-up but did not receive it
Q06
Multiple Choice
Which of the following digital features, if any, did you use for this visit? Select all that apply.
- Online booking
- Secure messaging
- View lab results
- Prescription refill
- Payment/checkout
- Order tracking for meds/devices
- None of the above
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?
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65+
- Prefer not to say
Q09
Message
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?
- Primary care
- Specialist visit
- Urgent care
- Telehealth/video visit
- Message-only consult
- Lab or imaging
- Pharmacy/medication delivery
- Other
Q11
Opinion Scale
Overall, how easy was it to get the care you needed?
Scale: 1 – 7
Min:Very difficultMax:Very easy
Q12
Opinion Scale
My provider listened carefully to me.
Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q13
Rating Scale
Overall, how would you rate your experience with the clinician you saw?
Range: 1 – 5
Min:PoorMax:Excellent
Q14
Opinion Scale
How easy was the website or app to use for your needs?
Scale: 1 – 5
Min:Very difficultMax:Very easy
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?
- Woman
- Man
- Non-binary
- Prefer not to say
Q17
Dropdown
Approximately how long did you wait past your scheduled appointment time?
- Seen on time or early
- 1–10 minutes
- 11–20 minutes
- 21–30 minutes
- 31–45 minutes
- More than 45 minutes
- Not applicable (e.g., telehealth, walk-in)
Q18
Opinion Scale
My provider explained things in a way I could understand.
Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q19
Opinion Scale
My main health concern was addressed or resolved during this visit.
Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q20
Dropdown
In which country do you currently reside?
- United States
- United Kingdom
- Canada
- Australia
- European Union
- Other country
- Prefer not to say
Q21
Opinion Scale
My provider showed respect for what I had to say.
Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q22
Opinion Scale
How likely are you to recommend our care to a friend or family member?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q23
Opinion Scale
I felt involved in decisions about my care.
Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
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.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Includes a dedicated AI follow-up interview segment that lets patients elaborate on their visit in their own words, beyond fixed-choice questions
- Covers the full experience arc in one instrument: appointment access and wait time, provider communication (listening, clarity, respect, involvement), follow-up timeliness, and digital touchpoint usage
- Pairs a clinician rating and an explicit recommend-likelihood question with an open-text improvement prompt, giving both quantifiable NPS-style benchmarking and qualitative signal
- Uses transparent, reviewable question and interview prompts plus automated scoring, so healthcare teams can audit exactly what was asked and how responses were evaluated
SurveySparrow
Free Patient Satisfaction Survey Template | For Healthcare IndustryA ready-to-use static patient satisfaction template covering standard experience dimensions like care quality and staff interaction. It's built for quick deployment across chat-style or classic survey formats but relies on fixed questions rather than adaptive probing. Good for teams wanting a fast baseline NPS-type survey without deeper qualitative follow-up.
What it does well
- Free, ready-to-field template aimed specifically at healthcare patient satisfaction
- Supports SurveySparrow's conversational-style survey format for better completion rates
- Likely includes standard satisfaction and NPS-style questions out of the box
Where it falls short
- No adaptive AI follow-up interview to probe individual patient answers in real time
- No indication of automated per-response quality scoring or transparent prompt methodology
- Static question set means all patients see the same questions regardless of their answers
QuestionPro
Health Insurance Satisfaction Survey TemplateThis template is focused on health insurance satisfaction rather than direct patient care experience (access, provider communication, follow-up), so it targets a narrower and somewhat different use case than a clinical patient experience survey. It's a standard fielding-ready form template within QuestionPro's broader survey platform. Useful if the goal is plan/insurer feedback rather than care-quality benchmarking.
What it does well
- Ready-to-use template within an established enterprise survey platform
- Likely includes robust reporting and cross-tab analysis tools typical of QuestionPro
- Can be customized within a mature survey-logic builder
Where it falls short
- Template topic (insurance) is not a direct match for care-quality/provider-communication measurement
- No adaptive AI-driven follow-up interviews or voice AI interview option
- No transparent, auditable prompt-level methodology for how responses are scored
SurveyMonkey
Patient Satisfaction Survey TemplateA post-visit patient satisfaction template covering common experience touchpoints, positioned as a straightforward fielding-ready survey. It's built on SurveyMonkey's traditional question-and-logic survey engine rather than any conversational or AI-driven interview format. Solid for basic post-visit pulse checks but limited for deeper qualitative insight.
What it does well
- Ready-to-field template from a well-known, widely trusted survey platform
- Likely supports skip logic and benchmarking against SurveyMonkey's question bank
- Simple setup for post-visit satisfaction pulse surveys
Where it falls short
- No adaptive AI or voice AI interview component for deeper follow-up on patient answers
- No automated per-response quality scoring described
- Fixed-form structure only, without guided screen-share tasks or conversational probing
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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