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.
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
26
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
Chat Message
Welcome and thank you for participating in this survey about your healthcare experiences.
This survey explores how well your healthcare provider fits your needs and what matters most to you when choosing providers. It takes approximately 6–8 minutes to complete.
Your participation is entirely voluntary, and you may stop at any time. There are no right or wrong answers — we are interested in your honest opinions. All responses are confidential and will be reported only in aggregate.
By continuing, you consent to participate.
Q2
Multiple Choice
Have you seen a healthcare provider for your own care in the past 6 months?
Yes
No
Q3
Multiple Choice
Which of the following reasons apply to why you have not seen a provider? Select all that apply.
Could not get an appointment
No need for care
Cost or coverage concerns
Transportation or distance
Unsure where to go
Other (please specify)
Prefer not to say
Q4
Multiple Choice
What type of healthcare provider did you most recently see?
Primary care physician
Specialist
Mental health professional
OB/GYN
Urgent care or retail clinic
Telehealth clinician
Other (please specify)
Prefer not to say
Q5
Multiple Choice
How did you choose this provider? Select all that apply.
Referred by another clinician
Chose from insurance network list
Friend or family recommendation
Online reviews or search
Assigned by clinic or insurer
I already knew this provider
Other (please specify)
Q6
Dropdown
In the past 6 months, approximately how many visits did you have with this provider?
1
2
3–4
5–6
7 or more
Unsure
Q7
Opinion Scale
Overall, how well did this provider fit your healthcare needs?
Range: 1 – 7
Min: Very poor fitMid: NeutralMax: Excellent fit
Q8
Opinion Scale
How easy was it to get an appointment that met your scheduling needs?
Which of the following, if any, were areas of mismatch with this provider? Select all that apply.
Clinical approach not aligned with my preferences
Limited appointment times
Communication style didn't suit me
Language barrier
Cultural sensitivity lacking
Location or travel inconvenient
Insurance or billing issues
Provider gender preference not met
Costs higher than expected
No mismatches
Other (please specify)
Q14
Multiple Choice
Do you plan to continue seeing this provider for similar healthcare needs?
Yes
No, I plan to switch
Unsure
Q15
Ranking
Please rank the following factors by how important they are to you when choosing a healthcare provider, from most to least important.
Drag to order (top = most important)
Clinical expertise in my condition
Communication style
Cultural understanding
Location or convenience
Appointment availability
Cost transparency
Provider gender
Q16
Multiple Choice
How would you most prefer to search for a well-matched provider?
Insurance directory with filters
Independent review site
Clinician referral
Community organization recommendations
Personalized matching app or tool
Other (please specify)
Q17
Opinion Scale
How confident are you that you could find a well-matched provider if you needed one?
Range: 1 – 7
Min: Not at all confidentMid: NeutralMax: Extremely confident
Q18
Long Text
What, if anything, would have improved the fit between you and this provider?
Max chars
Q19
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.
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 5
Q20
Dropdown
What is your age?
18–24
25–34
35–44
45–54
55–64
65 or older
Prefer not to say
Q21
Multiple Choice
Which gender best describes you?
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Q22
Dropdown
What is your highest level of education?
Less than high school
High school or equivalent
Some college
Associate degree
Bachelor's degree
Graduate or professional degree
Prefer not to say
Q23
Multiple Choice
How do you primarily pay for healthcare?
Employer-sponsored insurance
Individual or marketplace plan
Medicare
Medicaid or public program
Military/VA
Uninsured or self-pay
Prefer not to say
Q24
Dropdown
What is your preferred language for receiving healthcare?
English
Spanish
Chinese (Mandarin or Cantonese)
Vietnamese
Tagalog
Arabic
French
Korean
Another language
Prefer not to say
Q25
Dropdown
In which region do you usually receive healthcare?
U.S. — Northeast
U.S. — Southeast
U.S. — Midwest
U.S. — Southwest
U.S. — West
U.S. — Pacific (HI, AK)
Canada
United Kingdom
European Union
Other
Prefer not to say
Q26
Chat Message
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.
Frequently Asked Questions
What is QuestionPunk?
QuestionPunk is an AI-powered survey and research platform that turns traditional surveys into adaptive conversations. Describe your research goal and get a complete survey draft, conduct AI-moderated interviews with dynamic follow-ups, detect low-quality responses, and produce insights automatically. It's fast, flexible, and scalable across qualitative and quantitative research.
How do I create my first survey?
Sign up, then choose how to build: describe your research goal and let AI generate a survey, pick a template, or start from scratch. Add question types, set logic, preview, and share.
Can the AI generate a survey from a prompt?
Yes. Describe your research goal in plain language and QuestionPunk drafts a complete survey with appropriate question types, ordering, and AI follow-up logic. You can then customize before publishing.
What question types are available?
QuestionPunk supports a wide range of question types: opinion scale, rating, multiple choice, dropdown, ranking, matrix, constant sum, AI interview (text and audio), long text, short text, email, phone, date, address, website, numeric, audio/video recording, contact form, chat message, conversation reset, button, page breaks, and more.
How do AI interviews work?
AI interviews conduct adaptive conversations with respondents. The AI asks follow-up questions based on what the respondent says, probing for clarity and depth. You control the personality, tone, model (Haiku, Sonnet, or Opus), and question mode (fixed count, AI decides when to stop, or time-based).
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Yes. Use synthetic testing to create AI personas and run them through your survey. This helps catch issues with question flow, logic, and wording before real respondents see it.
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Can I export survey results?
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