When was your most recent visit to this facility?
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
About how many minutes did you wait from arrival/check-in until you were seen by a clinician?
Accepts a numeric value
Whole numbers only
After the visit ended, how many minutes did you wait for any follow-up steps (for example, labs, pharmacy, or discharge)?
Accepts a numeric value
Whole numbers only
Overall, how reasonable was your total time waiting during this visit?
Range: 1 – 10
Min: Very unreasonableMid: NeutralMax: Very reasonable
How easy was it to get an appointment when you needed it?
Scale: 10 (star)
Min: Very difficultMax: Very easy
Please rate your agreement with the following statements about access and availability.
| Rows | Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly agree |
|---|
| Clinic hours fit my schedule | • | • | • | • | • |
| Same-day or next-day appointments were available | • | • | • | • | • |
| Staff responded to calls or messages promptly | • | • | • | • | • |
| Appointment reminders were helpful | • | • | • | • | • |
| Telehealth was available when appropriate | • | • | • | • | • |
Which methods 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
Attention check: To show you are paying attention, please select "I am paying attention."
- I am paying attention
- I am not paying attention
- Prefer not to say
How clear were the clinician’s explanations about your condition and care plan?
Range: 1 – 10
Min: Not clear at allMid: Somewhat clearMax: Extremely clear
Did the clinician involve you in decisions to the extent you wanted?
- Yes, completely
- Yes, somewhat
- Not really
- Not at all
- Not applicable
Rank the aspects of counseling that mattered most in this visit (drag to order).
Drag to order (top = most important)
- Clear next steps and follow-up
- Risks and benefits explained
- Medication instructions
- Lifestyle or self-care guidance
- Time to ask questions
After the visit, how confident did you feel about managing your care?
Scale: 10 (star)
Min: Not at all confidentMax: Very confident
Overall, how satisfied were you with this visit?
Range: 1 – 10
Min: Not at all satisfiedMax: Very satisfied
What is your age group?
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65 or older
- Prefer not to say
Which best describes your gender?
- Woman
- Man
- Non-binary
- Prefer not to say
Where do you live?
- Africa
- Asia
- Europe
- Middle East
- North America
- Oceania
- South America
- Prefer not to say
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
What is your current employment status?
- Employed full-time
- Employed part-time
- Self-employed
- Unemployed, looking for work
- Unemployed, not looking for work
- Student
- Retired
- Unable to work
- Prefer not to say
What is one thing we could do to improve your experience?
Max 600 chars
AI Interview: 2 Follow-up Questions on Your Visit
AI InterviewLength: 2Personality: Expert InterviewerMode: Fast Thank you for your time—your feedback helps improve care.
Welcome! This brief survey asks about one recent healthcare visit. It takes about 3-5 minutes. Please answer based on your most recent visit.