A patient-facing needs assessment capturing menopause symptom burden, care access barriers, and service preferences to inform care model design and resource prioritization.
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
27
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 to the Menopause Care Needs & Preferences Survey.
This survey asks about your menopause-related symptoms, care experiences, and preferences for support. Your responses are confidential, will be reported only in aggregate, and will be used to improve menopause care services.
Participation is voluntary and you may stop at any time. There are no right or wrong answers — we are interested in your honest opinions and experiences.
Estimated time: 8–10 minutes.
Q2
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
Q3
Opinion Scale
How familiar are you with menopause care options available in your area?
Range: 1 – 7
Min: Not at all familiarMid: NeutralMax: Extremely familiar
Q4
Multiple Choice
Which of the following 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
Opinion Scale
Overall, how bothersome have your menopause-related symptoms been in the last 4 weeks?
Range: 1 – 7
Min: Not at all bothersomeMid: NeutralMax: Extremely bothersome
Q6
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 or service
Alternative or complementary practitioner (e.g., acupuncturist, naturopath)
Self-care only (over-the-counter, lifestyle changes)
I have not sought care for menopause symptoms
Other (please specify)
Prefer not to say
Q7
Chat Message
The next few questions ask about your most recent menopause-related care experience. If you have not received care, please select 'Not applicable' where available or skip ahead.
Q8
Opinion Scale
How would you rate your most recent care provider's knowledge of menopause?
Range: 1 – 7
Min: Very poorMid: NeutralMax: Excellent
Q9
Opinion Scale
How well did you feel heard and understood during your most recent menopause-related appointment?
Range: 1 – 7
Min: Not at all heardMid: NeutralMax: Completely heard
Q10
Opinion Scale
How clear was the care plan or next steps you received after your most recent menopause-related visit?
Range: 1 – 7
Min: Not at all clearMid: NeutralMax: Extremely clear
Q11
Dropdown
Approximately how long did you wait from first seeking help to your first menopause-related appointment?
Less than 1 week
1–2 weeks
3–4 weeks
1–2 months
3–6 months
More than 6 months
I have not sought a menopause-related appointment
Don't remember
Q12
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 or 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 (please specify)
No barriers experienced
Q13
Ranking
Rank the following sources from most to least preferred for getting menopause information.
Drag to order (top = most important)
Primary care provider or OB-GYN
Pharmacist
Specialist menopause clinic
Trusted health websites
Support groups or communities
Mobile app or digital program
Q14
Ranking
Rank the following service features from most to least important to you when choosing menopause care.
Drag to order (top = most important)
Clinicians with menopause expertise
Short wait times
Clear, personalized care plan
Insurance coverage and cost transparency
Follow-up and ongoing check-ins
Option for virtual and in-person visits
Culturally responsive and inclusive care
Q15
Dropdown
What is your preferred appointment format for menopause care?
In-person
Video visit
Phone
Chat or asynchronous messaging
No preference
Q16
Dropdown
What is the most you would be willing to pay per month out-of-pocket for a menopause support program, if not covered by insurance?
$0 — I would only use a free program
$1–$25
$26–$50
$51–$100
$101–$150
$151–$200
More than $200
Not sure
Q17
Opinion Scale
Overall, how satisfied are you with the menopause-related care and support you currently have access to?
Range: 1 – 7
Min: Very dissatisfiedMid: NeutralMax: Very satisfied
Q18
Opinion Scale
How likely are you to recommend your current menopause care provider or service to a friend or family member experiencing menopause?
Range: 0 – 10
Min: Not at all likelyMid: NeutralMax: Extremely likely
Q19
AI Interview
Based on your responses in this survey, please share any additional thoughts about your menopause care experience, unmet needs, or what you wish existed to better support you.
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 7
Q20
Chat Message
Finally, a few questions about you to help us understand different perspectives. Your responses are confidential.
Q21
Dropdown
What is your age?
18–24
25–34
35–44
45–54
55–64
65+
Prefer not to say
Q22
Multiple Choice
How do you describe your gender?
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Q23
Multiple Choice
What sex were you assigned at birth?
Female
Male
Intersex
Prefer not to say
Q24
Dropdown
Where do you currently live?
United States
Canada
United Kingdom
European Union
Australia / New Zealand
Other
Prefer not to say
Q25
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 or doctorate)
Prefer not to say
Q26
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
Q27
Chat Message
Thank you for completing this survey. Your responses will be kept confidential and used to improve menopause care services. We appreciate your time and openness.
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