formisoft

Telehealth Readiness Assessment Survey

Asks about available device type, internet connection type, and internet reliability rating. Built for practices expanding telehealth programs and screening patient readiness.

Questions
12
Pages
2
Time
about 3 min
Use this templatePrint it instead

Your practice

Telehealth Readiness Assessment Survey

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • 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

Formisoft for Mental Health

What's inside

Page 1 · Your information

  1. Patient NameText · Required
  2. Available Device TypeMultiple Choice · 4 choices
  3. Internet Connection TypeMultiple Choice · 5 choices
  4. Internet Reliability RatingMultiple Choice · 6 choices
  5. Private Space for Video VisitMultiple Choice · 4 choices

Page 2 · Additional details

  1. Comfort with Health Apps / PortalsLong Text
  2. Able to Upload Documents / PhotosMultiple Choice · 4 choices
  3. Need Pre-Visit Tech AssistanceMultiple Choice · 4 choices
  4. Preferred Visit ModalityMultiple Choice · 4 choices
  5. Accessibility NeedsLong Text

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Telehealth Readiness Assessment Survey, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

Related templates

All templates

Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Telehealth Readiness Assessment Survey for your practice, ready to send before the next visit.

BAA included · We set up your front desk

Use this template