Q01
Long Text
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Patient Experience & Satisfaction Survey (NPS + CSAT)
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.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
24 questions · ~4 min
Q02
Multiple Choice
When was your most recent visit with this clinic or provider?
Q03
Multiple Choice
How did you schedule or request this visit? Select all that apply.
Q04
Long Text
The following questions ask about the clinician you saw during this visit. Please indicate your level of agreement with each statement.
Q05
Multiple Choice
Which of the following technologies, if any, were part of this visit? Select all that apply.
Q06
Long Text
How likely are you to recommend this clinic or provider to a friend or family member?
Q07
Multiple Choice
What is your age?
Q08
Long Text
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].
Q09
Multiple Choice
What type of visit was it?
Q10
Long Text
How easy was it to schedule your appointment?
Q11
Long Text
My clinician listened carefully to my concerns.
Q12
Long Text
Overall, how reliable was the technology you used during this visit?
Q13
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?
Q14
Multiple Choice
Which gender do you identify with?
Q15
Long Text
Which best describes the service you received?
Q16
Multiple Choice
Approximately how long did you wait past your scheduled appointment time?
Q17
Long Text
My clinician explained my condition and treatment options clearly.
Q18
Long Text
If you experienced any technical issues during this visit, please briefly describe what happened.
Q19
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.
Q20
Long Text
Approximately how many healthcare visits have you had in the past 12 months?
Q21
Long Text
If scheduling was difficult, what specifically made it hard?
Q22
Long Text
My clinician treated me with courtesy and respect.
Q23
Long Text
My clinician spent enough time with me during the visit.
Q24
Rating Scale
Overall, how would you rate the quality of care you received during this visit?
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.
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.