All Templates

Patient Health Literacy & Plain Language Survey Template

Assess how well patients understand medical information. Use this template to test plain language and improve communication. 8-10 min; no personal data.

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

Sample Survey Items

Q1
Chat Message
Please think about your most recent clinic, hospital, or telehealth visit in the last 12 months as you answer. There are no right or wrong answers.
Q2
Multiple Choice
Which language do you prefer for health information?
  • English
  • Spanish
  • Chinese
  • Vietnamese
  • Arabic
Q3
Multiple Choice
Which materials would you like available in your preferred language? (Select all that apply)
  • Appointment reminders
  • Consent forms
  • Visit instructions
  • Bills and statements
  • Lab/test results
  • Medication labels
Q4
Opinion Scale
How confident are you filling out medical forms by yourself today?
Range: 1 – 10
Min: Not at allMid: SomewhatMax: Very
Q5
Matrix
Thinking about the last 12 months, how easy or hard were these to understand?
RowsVery easySomewhat easyNeither easy nor hardSomewhat hardVery hard
Prescription labels•••••
Appointment instructions•••••
Test result explanations•••••
Insurance or billing letters•••••
Q6
Long Text
Please list any medical words, phrases, or sections that were confusing in the last 12 months.
Max 600 chars
Q7
Multiple Choice
In the last 6 months, did you use a patient portal or app to view your health information?
  • Yes
  • No
Q8
Rating
If yes above: How clear was the information on the patient portal/app?
Scale: 10 (star)
Min: Very unclearMax: Very clear
Q9
Multiple Choice
In the last 12 months, did you have any telehealth (video or phone) visits?
  • Yes
  • No
Q10
Opinion Scale
If yes above: During telehealth visits, how often did you fully understand what to do next?
Range: 1 – 10
Min: NeverMid: About halfMax: Always
Q11
Multiple Choice
Which of these do you currently have access to? (Select all that apply)
  • Smartphone
  • Computer or tablet
  • Home internet/Wi‑Fi
  • Screen reader or text-to-speech
Q12
Multiple Choice
Do you have any of the following accessibility needs? (Select all that apply)
  • I have trouble reading small text
  • I prefer large print
  • I prefer audio or captions
  • None of these
Q13
Multiple Choice
Quality check: To confirm you are paying attention, please select “I am paying attention” below.
  • I am paying attention
  • I am not paying attention
Q14
Multiple Choice
How would you prefer to receive important instructions or results? (Select up to 3)
  • Printed handout
  • Text/SMS
  • Patient portal/app
  • Email
  • Phone call/voicemail
  • Short video
  • In‑person demonstration
Q15
Ranking
Rank these from most to least preferred for important instructions.
Drag to order (top = most important)
  1. Printed handout
  2. Patient portal/app
  3. Text/SMS
  4. Email
  5. Short video
Q16
Multiple Choice
Which formats help you understand best? (Select all that apply)
  • Bullet lists
  • Step‑by‑step checklists
  • Pictures or diagrams
  • Simple examples
  • Medical term plus plain‑language definition
  • Translated materials
  • Large print
Q17
Constant Sum
If we could simplify only a few areas, how would you divide 100 points among them?
Total must equal 100
Min per option: 0Whole numbers only
Q18
Dropdown
What is your age?
  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65–74
  • 75 or older
  • Prefer not to say
Q19
Multiple Choice
How do you describe your gender?
  • Woman
  • Man
  • Non‑binary
  • Prefer not to say
Q20
Dropdown
What is the highest level of education you have completed?
  • Less than high school
  • High school or GED
  • Some college or trade school
  • Associate degree
  • Bachelor’s degree
  • Graduate or professional degree
  • Prefer not to say
Q21
Dropdown
What is your current employment status?
  • Full‑time
  • Part‑time
  • Self‑employed
  • Homemaker or caregiver
  • Student
  • Retired
  • Not employed
  • Prefer not to say
Q22
Dropdown
Where do you live?
  • United States
  • United Kingdom
  • Canada
  • Australia
  • Other / Prefer not to say
Q23
Long Text
Anything else that would make health information easier for you to understand?
Max 600 chars
Q24
AI Interview
AI Interview: 2 Follow-up Questions on Health Information Clarity
AI InterviewLength: 2Personality: Expert InterviewerMode: Fast
Q25
Chat Message
Thank you for participating. Your feedback helps us make health information clearer and easier to use.

Ready to Get Started?

Launch your survey in minutes with this pre-built template

Use This TemplateBrowse More Templates