We would like to hear about your visit to our Telemedicine center. It would help us identify areas that we are doing well and those that may need improvement.
Did you make an appointment for your visit?
Yes
No
How long did you wait before you were seen? Less than 5 minutes
5 - 15 minutes
16 - 30 minutes
31 - 45 minutes
How would you rate the quality of service you received?
Excellent
Good
Fair
Poor
How far did you have to travel to get here?
KMs (one way)
How far would you have to travel to see the telemedicine provider in person?
KMs (one way)[The telemedicine provider is the out-of-town doctor or other health professional you saw on the TV.]
How
would you have handled your health
problem without telemedicine?
Would not have received health care at this point.
Would have received health care in my own community.
Would have traveled out of town for health care.
What town would you have traveled to for your health care?
How many miles is it from your home (one way)?
KMs
Do you think that the medical care you got from this telemedicine service is just as good as the care
you would get if you saw the physician face-to-face?
Yes, just as good
About the same
No, not as good
I’m not sure
Were you comfortable during the telemedicine consultation?
Yes, I was very comfortable
Yes, I was somewhat comfortable
No, I was somewhat uncomfortable
No, I was very uncomfortable
Was this telemedicine consultation more convenient than traveling to see a
specialist?
Yes, more convenient
About the same
No, less convenient
I would not have traveled to see a specialist
Did you have any trouble seeing or hearing the doctor during the telemedicine
consultation?
No, not at all
Yes, I had some trouble
Yes, I had a lot of trouble
Are you worried that telemedicine might not protect your privacy?
Yes, I am very worried
Yes, I am slightly worried
No, I am not worried
Would you recommend our telemedicine service to others?
Yes
Maybe
No
Would you use our telemedicine service again?
Yes
Maybe
No