Measures patient satisfaction across appointment scheduling, provider interaction quality, and health technology reliability using NPS and CSAT frameworks. Designed for clinics and health systems seeking actionable improvement data.
What's Included
AI-Powered Questions
Intelligent follow-up questions based on responses
Automated Analysis
Real-time sentiment and insight detection
Smart Distribution
Target the right audience automatically
Detailed Reports
Comprehensive insights and recommendations
Template Overview
24
Questions
AI-Powered
Smart Analysis
Ready-to-Use
Launch in Minutes
This professionally designed survey template helps you gather valuable insights with intelligent question flow and automated analysis.
Sample Survey Items
Q1
Chat Message
Welcome, and thank you for considering this survey.
This brief questionnaire takes approximately 5 minutes and asks about your recent healthcare visit—including scheduling, provider interaction, and any technology you used.
Your participation is entirely voluntary, and you may stop at any time. All responses are confidential, reported only in aggregate, and used solely for quality improvement purposes. There are no right or wrong answers; we simply value your honest opinions.
Q2
Multiple Choice
When was your most recent visit with this clinic or provider?
Within the last 7 days
1–4 weeks ago
1–3 months ago
More than 3 months ago
Not sure
Q3
Multiple Choice
What type of visit was it?
In-person visit
Video/telehealth
Phone consult
Messaging/portal only
Q4
Dropdown
Which best describes the service you received?
Primary care
Specialist
Urgent care
Diagnostic/imaging
Therapy/behavioral health
Other
Q5
Multiple Choice
How did you schedule or request this visit? Select all that apply.
Phone call
Online patient portal
Clinic website
Walk-in
Referral from another provider
Mobile app
Other
Q6
Opinion Scale
How easy was it to schedule your appointment?
Range: 1 – 7
Min: Very difficultMid: NeutralMax: Very easy
Q7
Multiple Choice
Approximately how long did you wait past your scheduled appointment time?
No wait or not applicable
1–10 minutes
11–20 minutes
21–30 minutes
31–60 minutes
More than 60 minutes
Q8
Long Text
If scheduling was difficult, what specifically made it hard?
Max chars
Q9
Chat Message
The following questions ask about the clinician you saw during this visit. Please indicate your level of agreement with each statement.
Overall, how would you rate the quality of care you received during this visit?
Scale: 5 (star)
Min: Very poorMax: Excellent
Q15
Multiple Choice
Which of the following technologies, if any, were part of this visit? Select all that apply.
None
Telehealth video
Patient portal/app (forms, messages)
Remote monitoring device
Kiosk or check-in tablet
Automated phone/SMS reminders
Other
Q16
Opinion Scale
Overall, how reliable was the technology you used during this visit?
Range: 1 – 7
Min: Very unreliableMid: NeutralMax: Very reliable
Q17
Long Text
If you experienced any technical issues during this visit, please briefly describe what happened.
Max chars
Q18
Opinion Scale
How likely are you to recommend this clinic or provider to a friend or family member?
Range: 0 – 10
Min: Not at all likelyMid: NeutralMax: Extremely likely
Q19
Long Text
Based on your responses in this survey, is there anything else you would like to share about your experience with access, provider interaction, or technology during this visit?
Max chars
Q20
AI Interview
We'd like to learn a bit more about your visit experience. An AI moderator will ask you a couple of brief follow-up questions based on your responses.
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 5
Q21
Multiple Choice
What is your age?
18–24
25–34
35–44
45–54
55–64
65 or older
Prefer not to say
Q22
Multiple Choice
Which gender do you identify with?
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Q23
Dropdown
Approximately how many healthcare visits have you had in the past 12 months?
0 (this was my first)
1–2
3–5
6–10
More than 10
Prefer not to say
Q24
Chat Message
Thank you for completing this survey. Your feedback is valuable and will be used to improve the quality of care and access at this clinic. If you have any questions or concerns, please contact [clinic contact information].
Frequently Asked Questions
What is QuestionPunk?
QuestionPunk is an AI-powered survey and research platform that turns traditional surveys into adaptive conversations. Describe your research goal and get a complete survey draft, conduct AI-moderated interviews with dynamic follow-ups, detect low-quality responses, and produce insights automatically. It's fast, flexible, and scalable across qualitative and quantitative research.
How do I create my first survey?
Sign up, then choose how to build: describe your research goal and let AI generate a survey, pick a template, or start from scratch. Add question types, set logic, preview, and share.
Can the AI generate a survey from a prompt?
Yes. Describe your research goal in plain language and QuestionPunk drafts a complete survey with appropriate question types, ordering, and AI follow-up logic. You can then customize before publishing.
What question types are available?
QuestionPunk supports a wide range of question types: opinion scale, rating, multiple choice, dropdown, ranking, matrix, constant sum, AI interview (text and audio), long text, short text, email, phone, date, address, website, numeric, audio/video recording, contact form, chat message, conversation reset, button, page breaks, and more.
How do AI interviews work?
AI interviews conduct adaptive conversations with respondents. The AI asks follow-up questions based on what the respondent says, probing for clarity and depth. You control the personality, tone, model (Haiku, Sonnet, or Opus), and question mode (fixed count, AI decides when to stop, or time-based).
Can I test my survey before launching?
Yes. Use synthetic testing to create AI personas and run them through your survey. This helps catch issues with question flow, logic, and wording before real respondents see it.
How many languages are supported?
QuestionPunk supports 142+ languages. Add languages from the survey editor, auto-translate questions, and share language-specific links. AI interviews also adapt to the respondent's language automatically.
How can I share my survey?
Share via a direct link (with optional custom slug), embed on your website (iframe or script), distribute through Prolific for research panels, or generate a QR code for physical distribution.
Can I export survey results?
Yes. Export as CSV (flat or wide layout), Excel (XLSX), or export the survey structure as PDF/Word. Filter by suspicious level, response type, language, or date range before exporting.
Does QuestionPunk detect fraudulent responses?
Yes. Every response is automatically classified with a suspicious level (low/medium/high) based on attention checks, response timing, and behavioral signals. You can filter flagged responses in the Responses tab.
What are the pricing plans?
Basic (Free): 20 responses/month. Business ($50/month or $500/year): 5,000 responses/month with priority support. Enterprise (Custom): unlimited responses, remove branding, custom domain, and dedicated support.
How long does support take to reply?
We reply within 24 hours, often much sooner. Include key details in your message to help us assist you faster.