Assesses barriers to mental health care, provider-patient fit, telehealth preferences, wait times, and affordability. Designed for health systems, insurers, and researchers seeking to identify actionable improvements in mental health service delivery.
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
31
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 mental health care access and experiences.
This survey is voluntary. You may skip any question or stop at any time. There are no right or wrong answers—we are interested in your honest opinions and experiences.
Your responses are confidential and will be reported only in aggregate. No personally identifying information will be shared. The results will be used to improve mental health services and provider matching.
The survey takes approximately 8–10 minutes to complete.
Q2
Multiple Choice
In the last 12 months, did you try to get mental health care?
Yes, I saw a provider
Yes, I tried but did not get an appointment
No
Prefer not to say
Q3
Multiple Choice
Which type(s) of mental health provider did you see in the last 12 months? Select all that apply.
Psychiatrist (MD/DO)
Psychologist (PhD/PsyD)
Therapist/Counselor (e.g., LCSW, LMFT, LPC)
Primary care clinician
Psychiatric nurse practitioner
Group therapy program
Other
Not applicable—I did not see a provider
Q4
Dropdown
Approximately how many mental health appointments did you have in the last 12 months?
0
1–3
4–6
7–12
13–24
25 or more
Q5
Opinion Scale
How well did your most recent provider's expertise match your needs?
Range: 1 – 7
Min: Not at all wellMid: NeutralMax: Extremely well
Q6
Opinion Scale
My most recent provider listened carefully to my concerns.
What, if anything, might keep you from seeking mental health care in the next 6 months? Select all that apply.
I feel fine / no need
Prefer self-help or informal support
Privacy or stigma concerns
Cost or coverage
Unsure how to get started
Scheduling or transportation
Past negative experience
Don't trust providers
Other
Nothing is likely to prevent me
Q21
Opinion Scale
How likely are you to seek mental health care in the next 6 months?
Range: 1 – 7
Min: Very unlikelyMid: NeutralMax: Very likely
Q22
Ranking
Please rank the following from most to least important when choosing a mental health provider.
Drag to order (top = most important)
Expertise that matches my concerns
Appointments available soon
Insurance accepted / low out-of-pocket cost
Good communication style / rapport
Cultural or language match
Telehealth availability
Location / convenience
Q23
Long Text
Based on your responses in this survey, please share any additional thoughts or feelings about your experience getting or receiving mental health care.
Max chars
Q24
AI Interview
We'd like to learn a bit more about your mental health care experience. An AI moderator will ask a couple of brief follow-up questions.
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 8
Q25
Dropdown
What is your age?
18–24
25–34
35–44
45–54
55–64
65+
Prefer not to say
Q26
Multiple Choice
Which best describes your gender?
Woman
Man
Non-binary or gender diverse
Prefer not to say
Q27
Dropdown
Where do you currently live?
United States
Canada
United Kingdom
Australia
European Union
Other
Q28
Dropdown
What is the highest level of education you have completed?
Less than high school
High school or GED
Some college / Associate degree
Bachelor's degree
Graduate or professional degree
Prefer not to say
Q29
Dropdown
What is your current employment status?
Full-time
Part-time
Self-employed
Student
Unemployed
Homemaker
Retired
Unable to work
Prefer not to say
Q30
Multiple Choice
How do you describe your race or ethnicity? Select all that apply.
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Multiple races/ethnicities
Other
Prefer not to say
Q31
Chat Message
Thank you for completing this survey. Your responses are confidential and will be used to help improve mental health care access and provider matching. If you are currently experiencing a mental health crisis, please contact the 988 Suicide & Crisis Lifeline by calling or texting 988.
Frequently Asked Questions
What is QuestionPunk?
QuestionPunk is a lightweight survey platform for live AI interviews you control. It's fast, flexible, and scalable—adapting every question in real time, moderating responses across languages, letting you steer prompts, models, and flows, and even generating surveys from a simple prompt. Get interview-grade insight with survey-level speed across qual and quant.
How do I create my first survey?
Sign up, then decide how you want to build: let the AI generate a survey from your prompt, pick a template, or start from scratch. Choose question types, set logic, and preview before sharing.
How can I share surveys with my team?
Send a project link so teammates can view and collaborate instantly.
Can the AI generate a survey from a prompt?
Yes. Provide a prompt and QuestionPunk drafts a survey you can tweak before sending.
How long does support typically take to reply?
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Can I export survey results?
Absolutely. Export results as CSV straight from the results page for quick data work.