Menopause Care Survey Template: Needs & Preferences
Use this menopause survey template to capture patient needs, care gaps, and preferred support across symptoms and resources. 8–12 minutes; start now.
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
23
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
Multiple Choice
Which of the following best describes your current menopause status?
Perimenopausal (periods changing, new symptoms)
In menopause (12 months without a period)
Postmenopausal
Not sure
Not experiencing menopause-related changes
Prefer not to say
Q2
Opinion Scale
How familiar are you with menopause care options available in your area?
Range: 1 – 10
Min: Not at all familiarMid: Moderately familiarMax: Very familiar
Q3
Rating
Overall, how bothersome have your menopause-related symptoms been in the last 4 weeks?
Scale: 11 (star)
Min: Not at all bothersomeMax: Extremely bothersome
Q4
Multiple Choice
Which symptoms have you experienced in the last 4 weeks? Select all that apply.
Hot flashes or night sweats
Sleep disruption or insomnia
Mood changes (e.g., anxiety, irritability)
Cognitive changes (e.g., brain fog, memory)
Vaginal dryness or discomfort
Low libido
Joint or muscle pain
Weight changes
Headaches or migraines
Other
None of the above
Prefer not to say
Q5
Multiple Choice
In the last 12 months, which types of support have you used for menopause symptoms? Select all that apply.
Primary care clinician/GP
OB-GYN/gynecology specialist
Endocrinologist
Nurse practitioner/physician assistant
Pharmacist guidance
Therapist/counselor
Support group (online or in-person)
Menopause-focused clinic/service
Alternative or complementary practitioner (e.g., acupuncturist, naturopath)
Self-care only (over-the-counter, lifestyle)
I have not sought care for menopause symptoms
Q6
Matrix
Thinking about your most recent menopause-related care, how would you rate each aspect? If you have not received care, you may skip this item.
Rows
Very poor
Poor
Fair
Good
Excellent
Ease of getting an appointment
•
•
•
•
•
Clinician’s knowledge of menopause
•
•
•
•
•
Respect and empathy
•
•
•
•
•
Clarity of information and guidance
•
•
•
•
•
Follow-up and continuity
•
•
•
•
•
Q7
Numeric
About how many days did you wait from first seeking help to your first appointment? Enter a whole number of days.
Accepts a numeric value
Whole numbers only
Q8
Multiple Choice
Attention check: To confirm attention, please select "Agree."
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Q9
Multiple Choice
What makes it hard to get the menopause support you want? Select all that apply.
Unsure where to seek care
Hard to get appointments
Cost/insurance coverage
Limited local specialists
Past negative experiences
Stigma or discomfort discussing symptoms
Transportation or childcare challenges
Time constraints
Privacy concerns
Symptoms feel manageable without care
Other
Q10
Long Text
Please describe any other barriers or details about getting help (optional).
Max 600 chars
Q11
Ranking
Rank the most helpful places you’d like to get menopause information.
Drag to order (top = most important)
Primary care/OB-GYN
Pharmacist
Specialist menopause clinic
Trusted health websites
Support groups/communities
Mobile app or digital program
Q12
Constant Sum
Allocate 100 points to show which service features matter most to you.
Total must equal 100
Clinicians with menopause expertise
Short wait times
Clear, personalized care plan
Insurance coverage/cost transparency
Follow-up and ongoing check-ins
Option for virtual and in-person visits
Culturally responsive and inclusive care
Coordination with your other clinicians
Min per option: 0Whole numbers only
Q13
Dropdown
If you could choose, what’s your preferred appointment format for menopause care?
In-person
Video visit
Phone
Chat/asynchronous messaging
No preference
Q14
Numeric
What is the maximum monthly amount you’d be willing to pay out-of-pocket for an effective menopause support program (if not covered)? Enter a whole number in your local currency.
Accepts a numeric value
Whole numbers only
Q15
Dropdown
What is your age?
18–24
25–34
35–44
45–54
55–64
65+
Prefer not to say
Q16
Multiple Choice
How do you describe your gender?
Woman
Man
Non-binary
Prefer not to say
Q17
Multiple Choice
What sex were you assigned at birth?
Female
Male
Intersex
Prefer not to say
Q18
Dropdown
Where do you currently live?
United States
Canada
United Kingdom
European Union
Australia/New Zealand
Other
Q19
Multiple Choice
What is the highest level of education you have completed?
High school or less
Some college or vocational
Bachelor’s degree
Postgraduate (master’s/doctorate)
Prefer not to say
Q20
Multiple Choice
What is your current employment status?
Full-time
Part-time
Self-employed
Unemployed and looking for work
Homemaker/caregiver
Student
Retired
Unable to work
Prefer not to say
Q21
Long Text
Anything else you wish existed to better support menopause care?
Max 600 chars
Q22
AI Interview
AI Interview: 2 Follow-up Questions on menopause care needs and preferences
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Q23
Chat Message
Thank you for participating—your input will help improve menopause care.
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