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.
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
22
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! This brief survey asks about one recent healthcare visit and takes about 4–6 minutes to complete.
Your participation is entirely voluntary and you may stop at any time. There are no right or wrong answers—we simply want your honest opinions. All responses are confidential and will be reported only in aggregate to help improve care quality.
Q2
Dropdown
When was your most recent visit to this facility?
Within the past week
1–2 weeks ago
3–4 weeks ago
1–2 months ago
3–6 months ago
More than 6 months ago
Q3
Dropdown
What type of visit was it?
Primary care
Specialist
Urgent care
Emergency department (ED)
Telehealth / virtual visit
Lab or imaging only
Pharmacy or medication counseling
Other
Q4
Dropdown
Approximately how many minutes did you wait from check-in until you were seen by a clinician?
Less than 5 minutes
5–14 minutes
15–29 minutes
30–44 minutes
45–59 minutes
60 minutes or more
Not applicable (e.g., telehealth)
Q5
Dropdown
After seeing the clinician, approximately how many minutes did you wait for follow-up steps (e.g., labs, pharmacy, or discharge instructions)?
No follow-up wait
Less than 5 minutes
5–14 minutes
15–29 minutes
30–44 minutes
45 minutes or more
Not applicable
Q6
Opinion Scale
Overall, how reasonable was the total time you spent waiting during this visit?
Range: 1 – 7
Min: Very unreasonableMid: NeutralMax: Very reasonable
Q7
Opinion Scale
How easy was it to get an appointment when you needed one?
Range: 1 – 7
Min: Very difficultMid: NeutralMax: Very easy
Q8
Opinion Scale
I was able to get an appointment within a timeframe that met my needs.
Which method(s) did you use to book this visit? Select all that apply.
Phone call
Website or patient portal
Mobile app
Walk-in (no appointment)
Referral scheduled by another clinic
Other
Q11
Opinion Scale
How clear were the clinician's explanations about your condition and care plan?
Range: 1 – 7
Min: Not at all clearMid: NeutralMax: Extremely clear
Q12
Multiple Choice
Did the clinician involve you in decisions about your care to the extent you wanted?
Yes, completely
Yes, somewhat
Not really
Not at all
Not applicable
Q13
Multiple Choice
Which aspect of counseling mattered most to you during this visit?
Clear next steps and follow-up
Risks and benefits explained
Medication instructions
Lifestyle or self-care guidance
Time to ask questions
Q14
Opinion Scale
After the visit, how confident did you feel about managing your health or care plan?
Range: 1 – 7
Min: Not at all confidentMid: NeutralMax: Extremely confident
Q15
Opinion Scale
Overall, how satisfied were you with this visit?
Range: 1 – 7
Min: Not at all satisfiedMid: NeutralMax: Extremely satisfied
Q16
Opinion Scale
How likely are you to recommend this facility to a friend or family member?
Range: 1 – 7
Min: Not at all likelyMid: NeutralMax: Extremely likely
Q17
Long Text
Based on your responses in this survey, what is one thing we could do to improve your visit experience?
Max chars
Q18
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.
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 6
Q19
Dropdown
What is your age group?
18–24
25–34
35–44
45–54
55–64
65 or older
Prefer not to say
Q20
Multiple Choice
Which best describes your gender?
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Q21
Dropdown
What is the highest level of education you have completed?
High school or less
Some college or associate degree
Bachelor's degree
Graduate or professional degree
Prefer not to say
Q22
Chat Message
Thank you for completing this survey. Your feedback is valuable and will be used to help improve care quality at this facility.
Frequently Asked Questions
What is QuestionPunk?
QuestionPunk is an AI-powered survey and research platform that turns traditional surveys into adaptive conversations. Describe your research goal and get a complete survey draft, conduct AI-moderated interviews with dynamic follow-ups, detect low-quality responses, and produce insights automatically. It's fast, flexible, and scalable across qualitative and quantitative research.
How do I create my first survey?
Sign up, then choose how to build: describe your research goal and let AI generate a survey, pick a template, or start from scratch. Add question types, set logic, preview, and share.
Can the AI generate a survey from a prompt?
Yes. Describe your research goal in plain language and QuestionPunk drafts a complete survey with appropriate question types, ordering, and AI follow-up logic. You can then customize before publishing.
What question types are available?
QuestionPunk supports a wide range of question types: opinion scale, rating, multiple choice, dropdown, ranking, matrix, constant sum, AI interview (text and audio), long text, short text, email, phone, date, address, website, numeric, audio/video recording, contact form, chat message, conversation reset, button, page breaks, and more.
How do AI interviews work?
AI interviews conduct adaptive conversations with respondents. The AI asks follow-up questions based on what the respondent says, probing for clarity and depth. You control the personality, tone, model (Haiku, Sonnet, or Opus), and question mode (fixed count, AI decides when to stop, or time-based).
Can I test my survey before launching?
Yes. Use synthetic testing to create AI personas and run them through your survey. This helps catch issues with question flow, logic, and wording before real respondents see it.
How many languages are supported?
QuestionPunk supports 142+ languages. Add languages from the survey editor, auto-translate questions, and share language-specific links. AI interviews also adapt to the respondent's language automatically.
How can I share my survey?
Share via a direct link (with optional custom slug), embed on your website (iframe or script), distribute through Prolific for research panels, or generate a QR code for physical distribution.
Can I export survey results?
Yes. Export as CSV (flat or wide layout), Excel (XLSX), or export the survey structure as PDF/Word. Filter by suspicious level, response type, language, or date range before exporting.
Does QuestionPunk detect fraudulent responses?
Yes. Every response is automatically classified with a suspicious level (low/medium/high) based on attention checks, response timing, and behavioral signals. You can filter flagged responses in the Responses tab.
What are the pricing plans?
Basic (Free): 20 responses/month. Business ($50/month or $500/year): 5,000 responses/month with priority support. Enterprise (Custom): unlimited responses, remove branding, custom domain, and dedicated support.
How long does support take to reply?
We reply within 24 hours, often much sooner. Include key details in your message to help us assist you faster.