Q01
Message
All templates
Patient Comfort With AI Scribes And Visit Documentation
Measures how comfortable patients are with AI tools that listen, transcribe, and summarize clinical visits, and what would make them trust those tools more. Built for health systems and clinics piloting AI documentation. An AI follow-up interview digs into the specific moment or topic that made a patient hesitant, going beyond a simple comfort score.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
14 questions · ~7 min
Q02
Multiple ChoiceRequired
Before today, had you heard of clinics using AI tools to listen to or write up notes during medical visits?
- Yes, I knew a fair amount about it
- I'd heard of it but didn't know much
- No, this is new to me
- Not sure
Q03
Multiple ChoiceRequired
In the last 12 months, has a doctor or clinician used an AI listening or note-taking tool during one of your visits?
- Yes, and I was told about it / asked for consent
- Yes, but I don't recall being asked
- Not that I know of
- Not sure
Q04
Opinion ScaleRequired
Overall, how comfortable are you with the idea of an AI tool listening to your conversation with your doctor to help write the visit notes?
Scale: 1 – 7
Min:Not at all comfortableMax:Extremely comfortable
Q05
MatrixRequired
How comfortable would you be with AI being used in each of these specific ways during your care?
5 rows × 5 columns
- AI transcribing your full conversation with the doctor
- AI writing the summary note that goes into your medical record
- AI suggesting billing or diagnosis codes based on the visit
- AI flagging symptoms or history details for follow-up care
- AI being used during a visit about a sensitive topic (e.g., mental health, substance use)
Columns: Very uncomfortable · Somewhat uncomfortable · Neutral · Somewhat comfortable · Very comfortable
Q06
Multiple Choice
What concerns you most, if anything, about AI-assisted documentation during your visits? Select all that apply.
- Privacy of the recorded conversation
- Accuracy of the AI-generated notes
- My doctor being less attentive because they're focused on the AI
- Not knowing who else can access the recording or notes
- How long recordings or notes are stored
- I don't have significant concerns
Q07
Best–Worst Trade-off (MaxDiff)Required
Which of these would do the most, and the least, to build your trust in AI-assisted documentation?
- A clear explanation of why AI is being used before my visit starts
- Being able to review and edit the AI-generated notes afterward
- Knowing exactly who can access the recording or notes
- My doctor being able to turn off the AI for sensitive parts of the visit
- Clear information about how long recordings are kept and when they're deleted
- Evidence that AI-assisted notes are more accurate than handwritten ones
- A simple way to opt out without affecting my care
Pick best & worst per setBest:Would build the most trustWorst:Would build the least trust
Q08
Multiple ChoiceRequired
How would you prefer to give consent before an AI tool is used to listen to or document your visit?
- Ask me verbally each time before recording starts
- Have me sign a form once per provider covering future visits
- Assume consent unless I say otherwise (opt-out)
- Only use it if I actively opt in ahead of time
- I don't have a strong preference
Q09
Opinion ScaleRequired
How much do you trust your doctor to review and correct anything the AI documentation tool gets wrong?
Scale: 1 – 5
Min:Not at allMax:Completely
Q10
AI Interview
Probe the reasoning behind the patient's comfort ratings, especially any use case they rated low or the sensitive-topic scenario. Ask them to describe a specific visit or moment where they'd feel differently, what exactly worries them (the recording itself, who sees it, or how it's used), and what single change — consent, review access, or an off switch — would most change their mind. If they say they have no concerns, ask what would make them reconsider that.
Q11
Message
Just a couple of quick background questions — both are optional.
Q12
Multiple Choice
Which age range do you fall into?
- Under 25
- 25–34
- 35–44
- 45–54
- 55–64
- 65 or older
- Prefer not to say
Q13
Multiple Choice
How often do you typically see a doctor or other clinician?
- Rarely, less than once a year
- A few times a year
- Monthly or more often
- I have an ongoing condition requiring regular visits
- Prefer not to say
Q14
Message
Thank you for your honest answers! Your responses will help shape how — and whether — AI documentation tools are introduced into patient care, including consent and privacy safeguards.
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.
Why this template
What this template is built to do — we found no directly comparable template from other survey tools to review.
What sets it apart
- Uses an AI follow-up interview to dig into the specific moment or topic that made a patient hesitant, rather than stopping at a single comfort score
- Combines an overall comfort rating with a matrix question breaking down comfort across specific AI documentation use cases (listening, transcribing, summarizing)
- Surfaces concrete trust-building levers via a max-diff exercise (what would most and least increase trust) alongside a consent-preference question
- Pairs quantitative scales (comfort, trust-in-doctor-review) with qualitative reasoning captured through adaptive AI probing, then rolls everything into an automated report
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.