Telehealth Appointment Experience Survey

Telehealth Appointment Experience Survey — Form Fields

This surveys template includes 9 fields. Evaluate patient satisfaction with telemedicine consultations and technology. Free to customize and use on ZenBuild.

• Type of telehealth appointment (dropdown selection, required) — options: Primary Care, Mental Health, Specialist Consultation, Follow-Up, Prescription Renewal
• Ease of Joining the Video Call (rating, required)
• Audio and Video Quality (rating, required)
• Provider Attentiveness (rating, required)
• Overall Quality of Care (rating, required)
• Did the telehealth visit meet your needs compared to in-person? (multiple choice, required) — options: Fully met my needs, Mostly met my needs, Partially met my needs, Did not meet my needs
• Technical issues experienced? (checkboxes, optional) — options: Connection Drops, Poor Audio, Poor Video, Login Problems, None
• Feedback on improving telehealth services (long text, optional)
• Would you use telehealth again? (multiple choice, required) — options: Definitely, Probably, Unsure, No