Q01
Message
All templates
Immediate Assistance Request Experience Survey
Measures how well your team handles in-the-moment help requests — response speed, staff helpfulness, and whether the issue actually got resolved — for any service that offers on-demand assistance (call buttons, chat, concierge, help desks). An AI follow-up interview reconstructs exactly what happened during the request, not just how it felt afterward.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
11 questions · ~6 min
Q02
Multiple ChoiceRequired
What kind of immediate assistance did you request most recently?
- Front desk / concierge help
- Technical or IT support
- Housekeeping or facilities issue
- Safety or medical concern
- Billing or account problem
Q03
NumberRequired
Roughly how many minutes passed between your request and someone responding to you?
Q04
Opinion ScaleRequired
How satisfied were you with how quickly your request was acknowledged?
Scale: 1 – 7
Min:Very dissatisfiedMax:Very satisfied
Q05
MatrixRequired
Thinking about that specific request, how much do you agree with each statement?
4 rows × 5 columns
- The person who helped me was courteous
- They clearly understood what I needed
- They kept me informed while working on it
- They followed up to confirm the issue was handled
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q06
Multiple ChoiceRequired
Was your issue fully resolved the first time you asked for help?
- Yes, fully resolved
- Partially resolved
- Not resolved, needed to ask again
- Not resolved at all
Q07
Rating ScaleRequired
Overall, how would you rate the helpfulness of the staff member who assisted you?
Range: 1 – 5
Min:Not helpful at allMax:Extremely helpful
Q08
Opinion ScaleRequired
How likely are you to reach out for help again the next time you need it, rather than trying to solve it yourself?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q09
AI Interview
Reconstruct exactly what happened during the respondent's most recent request for immediate assistance: how they made the request, what the wait actually felt like, what the staff member said or did, and the moment they knew (or didn't know) it was handled. If the issue wasn't fully resolved on the first try, probe what happened next and what would have fixed it faster. If satisfaction was high, find out which specific action by the staff member made the difference.
Q10
Multiple Choice
What is your age range?
- Under 25
- 25-34
- 35-44
- 45-54
- 55-64
- 65 or older
- Prefer not to say
Q11
Message
That's everything — thank you for the detailed feedback! Your responses go directly into a report we use to speed up and improve how our team handles urgent requests.
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
- Uses an AI follow-up interview to reconstruct exactly what happened during the respondent's most recent help request, not just a satisfaction rating after the fact
- Pairs a numeric response-time estimate and a matrix of agreement statements with rating and opinion-scale questions to triangulate speed, helpfulness, and resolution in one flow
- Asks directly whether the issue was fully resolved on the first attempt, so gaps between 'felt handled' and 'actually resolved' surface clearly
- Closes with an automated report generation step, so results are synthesized immediately rather than left as raw response exports
SurveySparrow
Immediate Assistant Request Form TemplateThis is a static, fielding-ready form template for logging immediate assistance requests, built on SurveySparrow's conversational-style form engine. It's a genuine topical match for on-demand help requests, but it's structured as an intake/request form rather than a post-experience survey measuring speed, helpfulness, and resolution. No mention of adaptive follow-up questioning or automated scoring.
What it does well
- Conversational one-question-at-a-time form format
- Ready-to-use template reduces setup time
- Fits SurveySparrow's broader form-building and distribution ecosystem
Where it falls short
- Fixed question set with no adaptive follow-up to probe what actually happened during the request
- No indication of automated per-response quality scoring
- Framed as a request-logging form, not an experience/satisfaction survey with reporting
Jotform
Free Local Assistance Request Form TemplateThis is a static drag-and-drop form template for collecting local assistance requests (intake-style), not a post-interaction experience survey. It's a reasonable adjacent reference since it covers assistance-request data collection, but it doesn't measure response speed, staff helpfulness, or resolution after the fact. No follow-up interviewing or analysis layer is described.
What it does well
- Free and easy to customize via Jotform's drag-and-drop builder
- Wide template library and integrations across Jotform's platform
- Good for simple intake logging of assistance requests
Where it falls short
- No adaptive AI interview to reconstruct the specifics of a past help request
- No built-in quality scoring or auto-generated reporting on responses
- Designed for request intake rather than evaluating speed, helpfulness, or resolution afterward
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.