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Healthcare & Clinical

Post-Visit Patient Support & Education Experience Survey

Measures patient perceptions of post-visit support access, health education clarity, and care coordination quality. Designed for healthcare organizations seeking to identify gaps in patient communication and follow-up processes.

Sample questions

A preview of what’s in the template. Every question is editable before you launch.

22 questions · ~10 min
Q01
Message

Welcome, and thank you for participating. This brief survey (approximately 10 minutes) asks about your most recent healthcare visit. Your participation is voluntary and you may stop at any time. There are no right or wrong answers — we are interested in your honest opinions. All responses are confidential and will be reported only in aggregate to help improve patient care.

Q02
Multiple Choice

When was your most recent healthcare visit?

  • Within the last 30 days
  • 1–3 months ago
  • 3–6 months ago
  • 6–12 months ago
  • More than 12 months ago
  • I have not had a visit in the past 12 months
Q03
Opinion Scale

How easy was it to reach your care team when you needed help?

Scale: 17
Min:Very difficultMax:Very easy
Q04
Opinion Scale

The explanations I received about my condition and treatment were clear and easy to understand.

Scale: 17
Min:Strongly disagreeMax:Strongly agree
Q05
Opinion Scale

The different providers involved in my care seemed to share information effectively with each other.

Scale: 17
Min:Strongly disagreeMax:Strongly agree
Q06
Opinion Scale

How confident are you in managing your health based on what you learned during your visit?

Scale: 17
Min:Not at all confidentMax:Extremely confident
Q07
AI Interview

We'd like to understand your experience in more detail. An AI moderator will ask you a couple of brief follow-up questions about the support and education you received.

Q08
Dropdown

What is your age?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65–74
  • 75+
  • Prefer not to say
Q09
Message

Thank you for completing this survey. Your feedback is valuable and will be used to improve patient support, education, and care coordination.

Q10
Multiple Choice

What type of care setting did you visit most recently?

  • Primary care / family medicine
  • Specialist clinic
  • Hospital outpatient clinic
  • Emergency or urgent care
  • Telehealth / virtual visit
  • Behavioral or mental health
  • Other
Q11
Multiple Choice

Which of the following support channels did you use to get help? Select all that apply.

  • Phone call
  • Patient portal messages
  • Email
  • Text / SMS
  • In-person nurse line or walk-in
  • 24/7 helpline
  • Support group or peer navigator
  • None of the above
  • Other
Q12
Multiple Choice

Were your questions answered in a way you could understand?

  • Yes, completely
  • Yes, somewhat
  • No
  • I did not have questions
Q13
Multiple Choice

Before you left, did you have a clear plan for your next steps in care?

  • Yes, a written plan
  • Yes, a verbal plan only
  • Partly
  • No
  • Not applicable
Q14
Opinion Scale

How likely are you to recommend this clinic or care team to a friend or family member?

Scale: 010
Min:Not at all likelyMax:Extremely likely
Q15
Long Text

What went particularly well during your most recent visit?

Q16
Multiple Choice

Which best describes your gender?

  • Woman
  • Man
  • Non-binary
  • Another identity
  • Prefer not to say
Q17
Multiple Choice

Which of the following educational resources did you find useful during or after your visit? Select all that apply.

  • Printed handouts or brochures
  • Videos or multimedia content
  • Patient portal articles or guides
  • Verbal explanations from a provider
  • Online resources recommended by the care team
  • Mobile app or digital tools
  • None of the above
  • I was not offered educational resources
  • Other
Q18
Dropdown

If you were referred to another provider, approximately how long did you wait between the referral and the appointment?

  • Less than 1 week
  • 1–2 weeks
  • 2–4 weeks
  • 1–2 months
  • More than 2 months
  • I am still waiting
  • Not applicable — I was not referred
Q19
Long Text

Based on your responses in this survey, is there anything else we could improve about support, education, or care coordination?

Q20
Dropdown

Where do you currently live?

  • United States
  • Canada
  • United Kingdom
  • Australia
  • India
  • Other
  • Prefer not to say
Q21
Dropdown

What is the highest level of education you have completed?

  • Less than high school
  • High school or equivalent
  • Some college or technical training
  • Bachelor's degree
  • Graduate or professional degree
  • Prefer not to say
Q22
Multiple Choice

Do you currently live with any ongoing health conditions? Select all that apply.

  • Diabetes
  • Heart or circulatory condition
  • Respiratory condition (e.g., asthma, COPD)
  • Mental health condition
  • Musculoskeletal or pain condition
  • Neurological condition
  • None of the above
  • Other
  • Prefer not to say

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 an AI follow-up interview segment that adaptively probes on the specifics of each patient's experience, going beyond fixed-choice ratings
  • Separately measures three distinct dimensions—access to post-visit support, clarity of health education, and cross-provider care coordination—rather than a single general satisfaction score
  • Captures concrete process gaps such as referral wait times and which support channels or educational resources were actually used
  • Closes with open-ended questions on what went well and what could improve, giving qualitative context to the quantitative scores

SurveyMonkey

Patient Satisfaction Survey Template

This is a ready-to-field static template focused on general post-visit satisfaction rather than a deep dive into support access, education clarity, or care coordination specifically. It's backed by SurveyMonkey's established survey infrastructure and benchmarking tools. As a fixed-question format, it relies on the same question set for every respondent with no adaptive follow-up.

What it does well

  • Purpose-built for the post-visit patient feedback use case
  • Backed by SurveyMonkey's mature survey distribution and analytics platform
  • Likely quick to deploy with minimal setup for standard satisfaction tracking

Where it falls short

  • Static question set with no adaptive AI probing to explore individual patient experiences further
  • No voice or conversational AI interview option to capture nuanced verbal feedback
  • No published methodology or prompt transparency for how questions were designed or scored

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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