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Telephone Appointment Patient Survey
1.
When your last telephone appointment was scheduled, how many days was it away from the date you booked it?
Same day
Next day
2 to 3 days
4 to 5 days
More than 5 days (please specify)
2.
Did you feel your health concern needed to be addressed within the same day or next day?
Yes
No
Wasn't sure
3.
Did you experience any issues or concerns about privacy or security in relation to your telephone appointment?
No
Yes (please specify)
4.
Did you experience any difficulty hearing/understanding your provider's instructions or have connection issues related to poor cell phone reception?
No
Yes (please provide details)
5.
Did you feel your health concern was addressed with the telephone appointment and that instructions from your provider were communicated as easily as an in-office visit?
Yes
No (please specify)
6.
Did your provider give you an opportunity to ask questions during your telephone appointment and did you feel they spent enough time with you?
Yes
No
7.
Do you you feel a telephone appointment was more convenient by saving you time or money (e.g. by not having to take time off work, arrange child care or travel)?
Yes
No
8.
How likely are you to choose a telephone appointment again once in-person visits become more available?
Very likely
Likely
Neither likely nor unlikely
Unlikely
Very unlikely
9.
Thinking of your most recent telephone appointment:
What was done particularly well:
What could be done to improve your experience:
10.
In order for us to better understand our survey results, please select your age:
19 or younger
20 to 29
30 to 39
40 to 49
50 to 59
60 to 69
70 to 79
80 or older
Prefer not to answer
11.
In general, how would you rate your overall health?
Excellent
Very Good
Good
Fair
Poor
Current Progress,
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