Q01
Message
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Contactless Health Check Experience Survey
Captures how patients and employees experience contactless vital-sign screening — camera- or sensor-based checks for temperature, heart rate, or oxygen — covering ease of use, trust in accuracy, and privacy comfort. Built for clinics and workplaces piloting no-touch screening, with an AI follow-up that probes what drove doubt or confidence in the reading.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
14 questions · ~7 min
Q02
Multiple ChoiceRequired
Where did you use the contactless health check?
- Doctor's office or clinic waiting room
- Workplace or office lobby
- Pharmacy or retail health kiosk
- Airport or travel screening point
- At home with a personal device
Q03
Multiple ChoiceRequired
Which of the following did the contactless check measure? Select all that apply.
- Body temperature
- Heart rate
- Blood oxygen level
- Respiratory rate
- Blood pressure
- Not sure
Q04
Rating ScaleRequired
How easy was it to complete the contactless health check?
Range: 1 – 5
Min:Very difficultMax:Very easy
Q05
Opinion ScaleRequired
How much did you trust the accuracy of the results compared to a traditional in-person check (e.g., thermometer, blood pressure cuff)?
Scale: 0 – 10
Min:Not at all confidentMax:Completely confident
Q06
MatrixRequired
How much do you agree with each statement about the contactless check?
5 rows × 5 columns
- The check felt fast
- I felt my privacy was respected
- The instructions were clear
- I felt comfortable with no physical contact
- I understood what my results meant
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q07
Multiple ChoiceRequired
Did you receive a clear explanation of your results?
- Yes, fully explained
- Mostly, but some questions remained
- Only a basic pass/fail result
- No explanation was given
Q08
AI Interview
Explore what specifically shaped this respondent's trust (or distrust) in the contactless reading — did they compare it to a past traditional check, notice inconsistent results, or feel rushed? If they said their results weren't clearly explained, ask what specific question went unanswered and what they did next (asked staff, looked it up, or ignored it).
Q09
Best–Worst Trade-off (MaxDiff)Required
When choosing between a contactless check and a traditional one, which of these matter most and least to you?
- Speed of the check
- Accuracy of the results
- Not being touched by equipment or staff
- Privacy of my health data
- How clearly results were explained
- Cost of the check
- Availability without an appointment
Pick best & worst per setBest:Matters mostWorst:Matters least
Q10
Multiple ChoiceRequired
Next time you have the option, would you choose a contactless health check over a traditional one?
- Definitely contactless
- Probably contactless
- No preference
- Probably traditional
- Definitely traditional
Q11
Long Text
Is there anything about the contactless check that confused you, worried you, or that you'd change?
Q12
Multiple Choice
What is your age range?
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65 or older
- Prefer not to say
Q13
Multiple Choice
How comfortable are you generally with health technology (apps, wearables, telehealth)?
- Very comfortable
- Somewhat comfortable
- Neutral
- Somewhat uncomfortable
- Very uncomfortable
- Prefer not to say
Q14
Message
That's everything — thank you! Your responses will help us improve the accuracy, clarity, and comfort of contactless health checks for future users.
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.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Includes an AI follow-up interview that explores what specifically drove a respondent's trust or distrust in the reading, going beyond a static trust-rating question
- Combines quantitative measures (rating, opinion scale, matrix, max-diff) with open-ended long-text and adaptive probing in one flow, so both patterns and reasons are captured
- Separates use-context (clinic vs. workplace), measurement type, and demographic/tech-comfort questions so results can be segmented without extra surveys
- Ends with a clear wrap-up message and produces an auto-generated report, so teams don't have to manually compile findings from a static form
QuestionPro
Contactless health check survey templateThis is the closest direct competitor, covering the same core topic of contactless vital-sign screening experience. It appears to be a standard fielding-ready template with fixed questions rather than an adaptive interview flow. No indication it offers voice-based or AI-probed follow-up on trust/accuracy perceptions.
What it does well
- Directly targets the same contactless health screening use case
- Likely offers quick deployment as a ready-made template within a broader survey platform
- Backed by an established survey platform with wide question-type support
Where it falls short
- No adaptive AI follow-up to probe why a respondent trusted or doubted the reading — likely fixed questions only
- No indication of voice AI interview capability or screen-share guided tasks
- No published methodology for how question order or logic was designed, unlike transparent prompt design
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.