Patient Experience Survey Reimbursement Impact Assessment Form
Please complete this assessment to help us understand how reimbursement may influence participation and completion of patient experience surveys. Your responses are confidential and do not include any personal or financial identifiers.
Have you ever completed a patient experience survey?
*
Yes
No
Were you offered any reimbursement or incentive to complete the survey?
*
Yes
No
Not sure
How much did the possibility of reimbursement influence your decision to participate in the survey?
*
Not at all
1
2
3
4
A great deal
5
1 is Not at all, 5 is A great deal
If you were not offered reimbursement, how likely would you be to complete a patient experience survey?
*
Very unlikely
1
2
3
4
Very likely
5
1 is Very unlikely, 5 is Very likely
Which type of incentive would most motivate you to complete a survey?
*
Gift card
Cash reimbursement
Charitable donation
No incentive needed
Other
How important is it to you that patient experience surveys remain voluntary and not tied to compensation?
*
Not important
1
2
3
4
Extremely important
5
1 is Not important, 5 is Extremely important
Please rate your agreement with the following statements about survey incentives.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Reimbursement increases my willingness to participate.
1
2
3
4
5
I believe incentives improve survey response rates.
6
7
8
9
10
I would complete surveys even without reimbursement.
11
12
13
14
15
In your opinion, what is the fairest way to offer reimbursement for survey participation?
*
Flat amount for all participants
Random drawing (raffle)
Based on time spent
No reimbursement should be offered
Other
How likely are you to recommend participation in patient experience surveys to others?
*
Not likely
1
2
3
4
Extremely likely
5
1 is Not likely, 5 is Extremely likely
Please share any additional comments or suggestions regarding reimbursement and patient experience surveys.
Submit Assessment
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