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Telehealth

Telehealth visit feedback template

Joining, audio and video, the clinician, resolution and whether the patient would choose video again.

5 questions · about 2 minutes to complete · free on every plan

More healthcare templates

Free account required. The template is copied into your workspace; edit anything before publishing.

When to use it
As the video call ends.
Who it is for
Patients who had a video or phone appointment.

How to use this template

  1. Ask about the technology and the clinician separately.
  2. Send it as the call ends; the link in the end screen performs best.
  3. Read open-text answers from the lowest scorers first; they explain the numbers.

Questions in the telehealth visit feedback template

  1. 1. How easy was it to join the appointment?

    rating

  2. 2. Any technical problems?

    single choice · None, Audio, Video, Connection dropped, Could not join on time

  3. 3. The clinician…

    matrix · Listened carefully, Explained things clearly, Addressed what I needed

  4. 4. Would you choose a video appointment again for a similar issue?

    single choice · Yes, Maybe, No, I would prefer in person

  5. 5. What would make telehealth better?

    open text

What the results look like

IllustrativeSynthetic sample of 120 responses generated for this preview, not real survey data. Your results page shows the same charts for your own responses.

1.How easy was it to join the appointment?

120 answered
Average 3.7
Answer distribution
AnswerCountPercent
165%
21613%
32823%
43227%
53832%

2.Any technical problems?

120 answered
Answer distribution
AnswerCountPercent
None1311%
Audio3630%
Video2924%
Connection dropped1210%
Could not join on time3025%

3.The clinician…

120 answered
StatementStrongly disagreeDisagreeNeutralAgreeStrongly agreen
Listened carefully11%12%15%30%33%120
Explained things clearly10%14%24%23%28%120
Addressed what I needed8%18%21%18%34%120

4.Would you choose a video appointment again for a similar issue?

120 answered
Answer distribution
AnswerCountPercent
Yes4941%
Maybe3529%
No, I would prefer in person3630%

How to read these questions

  • rating: Report the mean and the top-two-box share (the two highest points). Top-two-box is easier to explain and less sensitive to a few extreme answers.
  • single choice: Read the share choosing each option, then cross-tab by a segment question to see who differs.
  • matrix: Compare rows on the same column (for example, % agree) to find the weakest statement, then look at who rates it lowest.

Frequently asked questions

What should a telehealth survey ask?

Ease of joining, audio and video quality, whether the clinician listened and explained clearly, whether the issue was resolved, and whether they would choose video again.

How long does the telehealth visit feedback survey take to complete?

About 2 minutes: 5 questions, most of them single-tap. Every question can be edited, removed or reordered in the builder before you publish.

Is this template free to use?

Yes. Every template is included on the Free plan. Sign up, click Use this template, and it is copied into your workspace where you can edit it, add your logo and share it by link, email or embed.

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