It depends what I want to do. For intricate designs, I mark with template and chalk, or a pencil. But if you are doing something that mirrors the block design, sometimes you can use that as a guide and don't need a template. There are lots of freehand options that build on the stippling - hearts, leaves, circles, etc. intermixed into the stipple where ever you want. That's usually done freehand. And then there's things like
http://freemotionquilting.blogspot.ca/ where it's all done freehand and very dense quilting. I prefer lighter quilting, so I stick with what I said above.