
Telehealth Readiness Assessment Survey
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The Telehealth Readiness Assessment Survey helps healthcare organizations determine whether patients have the technology, connectivity, and confidence needed for a successful virtual visit before the appointment is scheduled. By proactively identifying barriers such as lack of a compatible device, unreliable internet, or discomfort with video conferencing, practices can offer targeted support, alternative visit modalities, or pre-visit tech checks that dramatically reduce no-shows and failed connections. This survey transforms telehealth from a one-size-fits-all offering into a patient-centered service matched to each individual's digital capability.
The survey evaluates the patient's available devices (smartphone, tablet, laptop, desktop), operating system and browser compatibility, internet connection type and reliability, and whether the patient has a private space suitable for a confidential video consultation. It assesses the patient's prior experience with video calls, comfort using healthcare portals and apps, and ability to perform basic tasks like uploading documents or taking and sending photos. Patients who self-identify as needing help are flagged for a pre-visit technology orientation call, ensuring that the actual clinical encounter runs smoothly.
This template is invaluable for practices expanding their telehealth programs, rural health clinics serving patients with limited broadband access, geriatric practices working with patients who may have lower digital literacy, and behavioral health providers where a reliable, private connection is essential for therapeutic rapport. Care coordinators use the results to triage patients into telehealth-ready, needs-support, and in-person-preferred categories, optimizing scheduling and resource allocation across the organization.
What's included
- Device availability and compatibility assessment
- Internet connection type, speed, and reliability evaluation
- Private consultation space and environment suitability check
- Digital literacy and health app comfort self-assessment
- Pre-visit technology assistance request flagging
- Accessibility needs and preferred visit modality capture
Who uses this template
- Practices expanding telehealth programs and screening patient readiness
- Rural health clinics assessing broadband access before scheduling virtual visits
- Geriatric practices identifying patients who need digital literacy support
- Behavioral health providers ensuring reliable and private video connections
All form fields
12 fields across 2 pages. Customize any field after signing up.
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