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Telemedicine Client Survey

In follow-up to your visit today, we ask that you complete the following brief survey so that we can work to continously improve how we provide telemedicine. Participation in the survey is completely voluntary and all your responses to the survey questions will be kept confidential.
How would you describe your overall satisfaction with today's visit?
Poor  Fair  Good  Very Good  Excellent  
Do you feel that receiving care via telemedicine was a good alternative to receiving care directly face to face?
Poor  Fair  Good  Very good  Excellent  
Was your privacy respected?
Poor  Fair  Good  Very Good  Excellent  
Would you use telemedicine again?
Definitely no  
Probably no  
Probably yes  
Definitely yes  
Did the telemedicine staff introduce themselves and explain their role?
Yes  No  
Did you have enough advance notice for your visit?
Yes  No  Needs Improvement  
Did you receive clear instructions on how to get to the studio?
Yes  No  Needs Improvement  
Was the information about the technology clear?
Yes  No  Needs Improvement  
Were you identified by name and birth date at the visit?
Yes  No  Needs Improvement  
Could you see the consultant clearly?
Yes  No  Needs Improvement  
Could you hear the consultant clearly?
Yes  No  Needs Improvement  
Were you given ample opportunity for questions?
Yes  No  Needs Improvement  
Was the follow up process made clear?
Yes  No  Needs Improvement  
Would you recommend this service to family and friends?
Definitely No  
Probably No  
Probably Yes  
Definitely Yes  
Additional comments or suggestions to improve service:
Thank you for completing our survey.
Enter the three black characters.
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