Q01
Message
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Media Request Response Experience Survey
Measures how journalists, freelancers, and other media professionals experience submitting interview, quote, or information requests to your press team — response speed, accuracy, and whether they got what they needed. An AI follow-up reconstructs exactly what happened on their most recent request, surfacing where the process broke down. Built for communications and media relations teams.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
Multiple ChoiceRequired
Thinking about your most recent media request to us, what kind of request was it?
- Interview request
- Request for a quote or statement
- Fact-check or data request
- Credentialing or event access request
- Photo, video, or b-roll request
Q03
Multiple ChoiceRequired
How did you submit that request?
- Phone call
- Online media request form
- Social media or direct message
- In person
Q04
Number
About how many hours passed before you received a first response (even just an acknowledgment)?
Q05
Opinion ScaleRequired
How satisfied were you with the speed of that response relative to your deadline?
Scale: 1 – 5
Min:Much slower than I neededMax:As fast as I needed
Q06
MatrixRequired
How much do you agree with each statement about your interaction with our press team on this request?
5 rows × 5 columns
- The information provided was accurate and complete
- The person who helped me was professional and easy to work with
- It was easy to reach the right contact
- The team was willing to work with my deadline
- I felt like a priority, not an afterthought
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q07
Best–Worst Trade-off (MaxDiff)Required
When you request information or access from an organization's press team, which of these matter most to you — and which matter least?
- Fast initial response
- Direct access to a spokesperson
- Accuracy and completeness of the information
- Flexibility around my deadline
- Availability for follow-up questions
- Exclusive or first access to information
- One clear point of contact throughout
Pick best & worst per setBest:Matters mostWorst:Matters least
Q08
Multiple ChoiceRequired
Did you end up getting what you needed for your story or coverage?
- Yes, I got everything I needed
- Partially — I got some but not all of what I needed
- No, I didn't get what I needed
- I'm still waiting on a response
Q09
AI Interview
Reconstruct exactly what happened on this respondent's most recent media request: what they asked for, who responded and how fast, and whether the final information or access matched what they needed for their story. If they said they only partially got what they needed or are still waiting, dig into specifically what was missing or delayed and what a better outcome would have looked like. If the request went smoothly, ask what specifically made it easy so it can be repeated.
Q10
Opinion ScaleRequired
How likely are you to reach out to this press team again for a future story?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q11
Multiple Choice
Which best describes where you work?
- Newspaper or magazine
- Television or radio
- Online news outlet or blog
- Trade or industry publication
- Podcast or newsletter
- Freelance
- Other
- Prefer not to say
Q12
Multiple Choice
Which best describes your role?
- Reporter or journalist
- Editor
- Producer
- Freelance contributor
- Communications or PR professional at another organization
- Other
- Prefer not to say
Q13
Message
That's everything — thank you for the candid feedback. Your responses go directly to our communications team to help us respond to media requests faster and more usefully going forward.
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 a numeric time-to-first-response question paired with a deadline-relative satisfaction scale, so speed is measured against what actually mattered to the journalist
- Uses a matrix of agreement statements plus a max-diff question to rank what journalists value most when working with a press team, not just a single satisfaction score
- An AI follow-up interview reconstructs exactly what happened on the respondent's most recent request, surfacing where the process broke down in their own words
- Captures outcome (did they get what they needed) and future intent (likelihood to reach out again) alongside role and outlet context, then rolls it all into an auto-generated report
Typeform
Media Request Form TemplateThis is an intake form for receiving media requests (e.g., interview or comment requests coming into a press team), not a survey measuring how journalists experienced that process afterward. It's a fielding-ready static form with Typeform's typical conversational UI, but it collects request details rather than feedback or satisfaction data. Useful as a front-door form, it doesn't overlap with post-interaction experience measurement.
What it does well
- Clean, conversational form-filling experience typical of Typeform
- Easy to share/embed for journalists submitting a request
- Simple setup for basic intake fields
Where it falls short
- Captures the request itself, not the requester's experience or satisfaction with how it was handled
- Static question flow with no adaptive follow-up to probe delays or breakdowns
- No mechanism to reconstruct what happened, score response quality, or auto-generate an experience report
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.