Q01
Long Text
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Patient-Provider Fit & Care Preference Assessment
Measures patient-provider alignment across clinical, communication, and access dimensions to identify mismatch drivers and care preferences. Designed for healthcare organizations, insurers, or researchers seeking to improve provider matching and patient retention.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
26 questions · ~4 min
Q02
Multiple Choice
Have you seen a healthcare provider for your own care in the past 6 months?
Q03
Multiple Choice
What type of healthcare provider did you most recently see?
Q04
Long Text
Overall, how well did this provider fit your healthcare needs?
Q05
Long Text
Please rank the following factors by how important they are to you when choosing a healthcare provider, from most to least important.
Q06
Long Text
What, if anything, would have improved the fit between you and this provider?
Q07
Long Text
What is your age?
Q08
Long Text
Thank you for completing this survey. Your responses will help improve how patients are matched with healthcare providers. If you have any questions about this research, please contact the study team at the email provided in your invitation.
Q09
Multiple Choice
Which of the following reasons apply to why you have not seen a provider? Select all that apply.
Q10
Multiple Choice
How did you choose this provider? Select all that apply.
Q11
Long Text
How easy was it to get an appointment that met your scheduling needs?
Q12
Multiple Choice
How would you most prefer to search for a well-matched provider?
Q13
AI Interview
Based on your earlier responses, we'd like to explore your patient–provider fit experiences in a bit more depth. Please share your thoughts, and our moderator will ask a couple of follow-up questions.
Q14
Multiple Choice
Which gender best describes you?
Q15
Long Text
In the past 6 months, approximately how many visits did you have with this provider?
Q16
Long Text
This provider listened carefully to my concerns.
Q17
Long Text
How confident are you that you could find a well-matched provider if you needed one?
Q18
Long Text
What is your highest level of education?
Q19
Long Text
This provider explained things in a way I could understand.
Q20
Multiple Choice
How do you primarily pay for healthcare?
Q21
Long Text
This provider involved me in decisions about my care.
Q22
Long Text
What is your preferred language for receiving healthcare?
Q23
Long Text
This provider showed respect for my background and preferences.
Q24
Long Text
In which region do you usually receive healthcare?
Q25
Multiple Choice
Which of the following, if any, were areas of mismatch with this provider? Select all that apply.
Q26
Multiple Choice
Do you plan to continue seeing this provider for similar healthcare needs?
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.