Telehealth Experience Survey
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Telehealth Experience Survey

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formisoft.com/f/telehealth-experience-survey
Telehealth Experience Survey
Visit Date
Technology Ease of Use
Audio Quality
Video Quality
Technical Difficulties
Provider Engagement
Privacy Comfort Level
Effectiveness vs In-Person
Would Use Telehealth Again
Suggestions for Improvement
Submit

The Telehealth Experience Survey is purpose-built for evaluating patient satisfaction with virtual visits, capturing the unique aspects of remote care delivery that traditional in-office surveys do not address. As telehealth becomes a permanent component of healthcare delivery, understanding how patients experience virtual visits is essential for optimizing your telemedicine program. This survey measures technology ease of use, audio and video quality, provider attentiveness during the virtual encounter, and whether the patient felt the visit was as effective as an in-person appointment.

The survey covers the entire telehealth journey starting with how easy it was to access the virtual waiting room, whether the patient received adequate pre-visit technical instructions, and how smoothly the connection was established. Patients rate the audio and video quality during the encounter, whether technical difficulties interrupted the visit, and how well the provider adapted their communication style to the virtual format. Questions about privacy comfort assess whether the patient felt confident discussing sensitive health information over video, which is critical for maintaining trust in the telehealth modality.

Designed for any practice offering synchronous video visits, this survey supports primary care telemedicine programs, behavioral health teletherapy practices, specialist e-consult services, and hybrid practices balancing in-person and virtual appointment options. The feedback helps IT teams address technical barriers, trains providers on virtual bedside manner, and informs strategic decisions about which visit types are best suited for telehealth versus in-person care delivery.

What's included

  • Technology usability and platform access assessment
  • Audio and video quality ratings for the encounter
  • Technical difficulty reporting and troubleshooting feedback
  • Provider virtual engagement and communication evaluation
  • Privacy comfort and telehealth confidence measurement
  • Telehealth versus in-person effectiveness comparison

Who uses this template

  • Primary care practices evaluating their telemedicine program quality
  • Behavioral health providers assessing teletherapy patient satisfaction
  • Specialist practices optimizing e-consult and virtual visit workflows
  • Hybrid practices determining ideal visit types for virtual delivery

All form fields

10 fields across 1 page. Customize any field after signing up.

Visit DateDate
Technology Ease of UseMultiple Choice
Audio QualityMultiple Choice
Video QualityMultiple Choice
Technical DifficultiesMultiple Choice
Provider EngagementMultiple Choice
Privacy Comfort LevelMultiple Choice
Effectiveness vs In-PersonMultiple Choice
Would Use Telehealth AgainMultiple Choice
Suggestions for ImprovementLong Text

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