Q01
Long Text
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Patient Health Literacy & Plain Language Assessment
Measures how well patients understand medical information across print, digital, and telehealth channels. Designed for healthcare communicators seeking to identify comprehension barriers and optimize plain-language materials.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
25 questions · ~4 min
Q02
Multiple Choice
In the last 12 months, have you had at least one clinic, hospital, or telehealth visit?
Q03
Long Text
How confident are you in your ability to fill out medical forms by yourself?
Q04
Multiple Choice
In the last 12 months, did you use a patient portal or app to view your health information?
Q05
Multiple Choice
Which of the following do you currently have access to? (Select all that apply)
Q06
Long Text
Please rank the following from most to least preferred for receiving important health instructions or results.
Q07
Long Text
Based on your responses in this survey, is there anything else that would make health information easier for you to understand?
Q08
Long Text
What is your age?
Q09
Long Text
Thank you for participating. Your feedback helps us make health information clearer and easier to use for everyone.
Q10
Multiple Choice
Which language do you prefer for health information?
Q11
Long Text
Overall, how easy or difficult was it to understand the written health information you received in the last 12 months?
Q12
Long Text
How clear was the health information displayed on the patient portal or app?
Q13
Multiple Choice
Which of the following would help you when reading health information? (Select all that apply)
Q14
Multiple Choice
Which of the following formats help you understand health information best? (Select all that apply)
Q15
AI Interview
We'd like to learn a bit more about your experience. An AI interviewer will ask you a couple of follow-up questions about understanding health information.
Q16
Multiple Choice
How do you describe your gender?
Q17
Multiple Choice
In the last 12 months, which types of health information were difficult for you to understand? (Select all that apply)
Q18
Multiple Choice
In the last 12 months, did you have any telehealth (video or phone) visits?
Q19
Multiple Choice
Which of the following materials would you most like to have available in your preferred language? (Select all that apply)
Q20
Long Text
What is the highest level of education you have completed?
Q21
Long Text
Please list any medical words, phrases, or sections of documents that were confusing to you in the last 12 months.
Q22
Long Text
During your telehealth visits, how often did you fully understand what to do after the visit ended?
Q23
Long Text
If we could simplify only a few areas of health information, which would help you the most? Please rank from most to least important.
Q24
Long Text
What is your current employment status?
Q25
Long Text
In which country do you currently live?
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.