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Sexual Health Testing Experience & Awareness Survey

Measures how people access, experience, and think about STI/STD testing services — testing frequency, comfort with providers, and the practical or emotional barriers that keep people from testing regularly. Built for sexual health clinics and public health teams, with an AI follow-up that digs into the real reasons behind gaps in testing behavior.

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Sample questions

A preview of what’s in the template. Every question is editable before you launch.

13 questions · ~7 min
Q01
Message

Thanks for taking a few minutes to share your experience with sexual health testing. Everything you share is confidential and there are no wrong answers — this should take about 4-5 minutes.

Q02
Multiple ChoiceRequired

In the last 12 months, how many times have you been tested for STIs?

  • Never
  • Once
  • Two or three times
  • Four or more times
  • I'm not sure / can't recall
Q03
Multiple Choice

Where have you gotten tested for STIs before (select all that apply)?

  • Primary care doctor's office
  • Sexual health / STI clinic
  • Pharmacy or urgent care
  • At-home test kit
  • Community health event or outreach van
  • I have never been tested
Q04
Opinion ScaleRequired

How comfortable do you feel discussing STI testing and sexual health with a healthcare provider?

Scale: 1 – 7
Min:Very uncomfortableMax:Very comfortable
Q05
MatrixRequired

How much does each of the following get in the way of you getting tested when you think you should?

6 rows × 4 columns
  • Cost of testing
  • Concerns about privacy or confidentiality
  • Finding time or a convenient location
  • Embarrassment or stigma
  • Not having symptoms, so it doesn't feel urgent
  • +1 more
Columns: Not a barrier · Minor barrier · Moderate barrier · Major barrier
Q06
Rating Scale

If you've been tested before, how would you rate your most recent testing experience overall?

Range: 1 – 5
Min:Very poorMax:Excellent
Q07
Multiple Choice

What would most encourage you to get tested more regularly (select all that apply)?

  • Lower cost or free testing
  • More privacy or anonymous options
  • Faster results
  • Easier scheduling or walk-in availability
  • A trusted at-home test option
  • Being asked/reminded by a provider
  • More open conversations with partners
Q08
AI Interview

Reconstruct the respondent's actual decision-making around their most recent testing experience (or lack of one): what prompted them to consider testing, what almost stopped them, and what specifically made it easy or hard. If they selected 'Never' been tested, gently probe what would need to change — cost, privacy, stigma, or access — for them to seriously consider it, without being judgmental. If they rated a barrier as 'major', ask for a concrete recent example of that barrier in action.

Q09
Opinion Scale

How likely are you to recommend the testing service or provider you used to a friend?

Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q10
Multiple Choice

What is your age range?

  • Under 18
  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55+
  • Prefer not to say
Q11
Multiple Choice

How do you describe your gender identity?

  • Woman
  • Man
  • Non-binary
  • Prefer not to say
Q12
Multiple Choice

How do you describe your sexual orientation?

  • Heterosexual/straight
  • Gay or lesbian
  • Bisexual
  • Prefer not to say
Q13
Message

That's everything — thank you for your openness. Your answers will be combined with others to help improve access to sexual health testing and make the experience less stressful for everyone.

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 reconstructs the respondent's actual decision-making around their most recent testing experience, surfacing real reasons behind testing gaps that fixed-choice questions can't capture.
  • Pairs a matrix question quantifying specific barriers (cost, embarrassment, access, etc.) with opinion-scale items on comfort discussing testing with providers and likelihood to recommend the service.
  • Covers testing frequency, where people have been tested, and a rating of their most recent experience, plus age, gender identity, and sexual orientation breakouts for segmentation by clinics and public health teams.
  • Automated per-response quality scoring and auto-generated reports turn open-ended answers (including from an optional voice AI interview) into analyzable output without manual coding.

QuestionPro

Sexually transmitted disease survey questions + sample questionnaire template

This page presents sample STD survey questions and a questionnaire template, functioning more like a question-bank/guide than a ready-to-field survey bundled with reporting. It covers standard topics (testing history, knowledge, attitudes) using conventional question types, aimed at researchers building their own instrument.

What it does well

  • Broad sample question bank covering STD knowledge and testing topics
  • Backed by an established, well-known survey platform
  • Customizable questionnaire structure researchers can adapt

Where it falls short

  • No adaptive AI follow-up to probe why respondents skip or delay testing — relies on static fixed-choice and scaled questions
  • No automated per-response quality scoring or auto-generated report output evident on the page
  • No transparent, published interview prompt methodology

Jotform

Sexually Transmitted Infection Report Form Template

This is a report/documentation form for recording STI cases, not a survey measuring testing experience, comfort, or barriers — a different use case (clinical/administrative reporting vs. attitudinal research). It's a static form builder template with no interview-style questioning or behavioral/attitude scales.

What it does well

  • Simple, quick-to-deploy form builder for capturing structured STI case data
  • Familiar drag-and-drop customization within the Jotform ecosystem

Where it falls short

  • Not designed to measure testing frequency, comfort, or barriers — serves a reporting purpose rather than survey research
  • No adaptive AI follow-up or voice interview capability
  • No automated quality scoring or auto-generated analytical reports

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.

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