Q01
Long Text
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Patient Visit Satisfaction: Wait Times, Access & Counseling
Measures patient satisfaction with a recent healthcare visit across three domains—wait times, appointment access, and clinician counseling quality. Suitable for clinics, hospitals, and health systems seeking actionable feedback to improve the patient experience.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
22 questions · ~4 min
Q02
Long Text
When was your most recent visit to this facility?
Q03
Long Text
Approximately how many minutes did you wait from check-in until you were seen by a clinician?
Q04
Long Text
How easy was it to get an appointment when you needed one?
Q05
Long Text
How clear were the clinician's explanations about your condition and care plan?
Q06
Long Text
Overall, how satisfied were you with this visit?
Q07
Long Text
Based on your responses in this survey, what is one thing we could do to improve your visit experience?
Q08
Long Text
What is your age group?
Q09
Long Text
Thank you for completing this survey. Your feedback is valuable and will be used to help improve care quality at this facility.
Q10
Long Text
What type of visit was it?
Q11
Long Text
After seeing the clinician, approximately how many minutes did you wait for follow-up steps (e.g., labs, pharmacy, or discharge instructions)?
Q12
Long Text
I was able to get an appointment within a timeframe that met my needs.
Q13
Multiple Choice
Did the clinician involve you in decisions about your care to the extent you wanted?
Q14
Long Text
How likely are you to recommend this facility to a friend or family member?
Q15
AI Interview
We'd like to understand your experience in a bit more depth. An AI moderator will ask a couple of brief follow-up questions based on your earlier responses.
Q16
Multiple Choice
Which best describes your gender?
Q17
Long Text
Overall, how reasonable was the total time you spent waiting during this visit?
Q18
Long Text
The facility offered appointment times that were convenient for my schedule.
Q19
Multiple Choice
Which aspect of counseling mattered most to you during this visit?
Q20
Long Text
What is the highest level of education you have completed?
Q21
Multiple Choice
Which method(s) did you use to book this visit? Select all that apply.
Q22
Long Text
After the visit, how confident did you feel about managing your health or care plan?
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.