Q01
Message
All templatesSample Templates
Patient Visit Satisfaction: Wait Times, Access & Counseling
Measures patient satisfaction with a recent healthcare visit across three domains—wait times, appointment access, and clinician counseling quality. Suitable for clinics, hospitals, and health systems seeking actionable feedback to improve the patient experience.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
22 questions · ~10 min
Q02
Dropdown
When was your most recent visit to this facility?
- Within the past week
- 1–2 weeks ago
- 3–4 weeks ago
- 1–2 months ago
- 3–6 months ago
- More than 6 months ago
Q03
Dropdown
Approximately how many minutes did you wait from check-in until you were seen by a clinician?
- Less than 5 minutes
- 5–14 minutes
- 15–29 minutes
- 30–44 minutes
- 45–59 minutes
- 60 minutes or more
- Not applicable (e.g., telehealth)
Q04
Opinion Scale
How easy was it to get an appointment when you needed one?
Scale: 1 – 7
Min:Very difficultMax:Very easy
Q05
Opinion Scale
How clear were the clinician's explanations about your condition and care plan?
Scale: 1 – 7
Min:Not at all clearMax:Extremely clear
Q06
Opinion Scale
Overall, how satisfied were you with this visit?
Scale: 1 – 7
Min:Not at all satisfiedMax:Extremely satisfied
Q07
Long Text
Based on your responses in this survey, what is one thing we could do to improve your visit experience?
Q08
Dropdown
What is your age group?
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65 or older
- Prefer not to say
Q09
Message
Thank you for completing this survey. Your feedback is valuable and will be used to help improve care quality at this facility.
Q10
Dropdown
What type of visit was it?
- Primary care
- Specialist
- Urgent care
- Emergency department (ED)
- Telehealth / virtual visit
- Lab or imaging only
- Pharmacy or medication counseling
- Other
Q11
Dropdown
After seeing the clinician, approximately how many minutes did you wait for follow-up steps (e.g., labs, pharmacy, or discharge instructions)?
- No follow-up wait
- Less than 5 minutes
- 5–14 minutes
- 15–29 minutes
- 30–44 minutes
- 45 minutes or more
- Not applicable
Q12
Opinion Scale
I was able to get an appointment within a timeframe that met my needs.
Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q13
Multiple Choice
Did the clinician involve you in decisions about your care to the extent you wanted?
- Yes, completely
- Yes, somewhat
- Not really
- Not at all
- Not applicable
Q14
Opinion Scale
How likely are you to recommend this facility to a friend or family member?
Scale: 1 – 7
Min:Not at all likelyMax:Extremely likely
Q15
AI Interview
We'd like to understand your experience in a bit more depth. An AI moderator will ask a couple of brief follow-up questions based on your earlier responses.
Q16
Multiple Choice
Which best describes your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q17
Opinion Scale
Overall, how reasonable was the total time you spent waiting during this visit?
Scale: 1 – 7
Min:Very unreasonableMax:Very reasonable
Q18
Opinion Scale
The facility offered appointment times that were convenient for my schedule.
Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q19
Multiple Choice
Which aspect of counseling mattered most to you during this visit?
- Clear next steps and follow-up
- Risks and benefits explained
- Medication instructions
- Lifestyle or self-care guidance
- Time to ask questions
Q20
Dropdown
What is the highest level of education you have completed?
- High school or less
- Some college or associate degree
- Bachelor's degree
- Graduate or professional degree
- Prefer not to say
Q21
Multiple Choice
Which method(s) did you use to book this visit? Select all that apply.
- Phone call
- Website or patient portal
- Mobile app
- Walk-in (no appointment)
- Referral scheduled by another clinic
- Other
Q22
Opinion Scale
After the visit, how confident did you feel about managing your health or care plan?
Scale: 1 – 7
Min:Not at all confidentMax:Extremely confident
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.
Frequently asked questions
What questions are in the “Patient Visit Satisfaction: Wait Times, Access & Counseling” template?
The template includes 22 ready-to-use questions, starting with: “Welcome! This brief survey asks about one recent healthcare visit and takes about 10 minutes to complete. Your participa…” · “When was your most recent visit to this facility?” · “Approximately how many minutes did you wait from check-in until you were seen by a clinician?”. The full set is previewed above, and every question is editable.
How long does this survey take to complete?
Respondents typically finish the 22 questions in about 10 minutes.
Can I customize this template?
Yes — every question, answer option, and the ordering is editable before you launch. You can add or remove questions, or ask the AI editor to rework the survey around your research goal.
Is this template free to use?
Yes. Open it in the editor and start customizing right away — no account required to try it, and the free plan covers launching your survey.
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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