Black River Local School District - Telehealth Survey

Thank you for your time and feedback regarding this telehealth survey. The responses from you and other parents will help Black River Local School District determine if school-based telehealth services are a beneficial option.

Question Title

* 1. If your school had access to telehealth services where your child could be seen by a healthcare professional to diagnose your child’s problem, prescribe medications (if needed), and virtually add you to the provider visit, would you be interested?

Yes

Question Title

* 2. What would be the important benefits for your child if/when he/she receives school telehealth services? Check all that apply.

Management of chronic illness

Quick medical care and diagnosis with prescription readily available

I don't have to leave work

Reduce absenteeism for my child

Question Title

* 3. How far is your primary care physician from your child’s school?

< 20 miles

Between 20 and 40 miles

> 40 miles

Question Title

* 4. How far is your pharmacy from your child’s school?

< 20 miles

Between 20 and 40 miles

> 40 miles

Question Title

* 5. With this initiative you will be asked to sign a telehealth consent form for your child at the beginning of the school year. Would it be your preference to sign another consent at the time of the virtual visit?

No, the yearly consent is enough

Yes, but only if a parent is unable to make the virtual visit

Yes, for the first virtual visit only

Yes, for each virtual visit

Question Title

* 6. Telehealth in schools is very similar to telehealth with your own primary care doctor; access to reliable technology is key to a successful appointment. Do you have reliable online services where you could log into the appointment? (i.e. smart phone, laptop/computer access)

Yes, I have a smartphone, laptop/computer to use

Yes, I have a smartphone, laptop/computer to use but my internet access is sketchy at times

No, I do not have access to reliable online services

Black River Local School District - Telehealth Survey

Question Title

* 1. If your school had access to telehealth services where your child could be seen by a healthcare professional to diagnose your child’s problem, prescribe medications (if needed), and virtually add you to the provider visit, would you be interested?

Question Title

* 2. What would be the important benefits for your child if/when he/she receives school telehealth services? Check all that apply.

Question Title

* 3. How far is your primary care physician from your child’s school?

Question Title

* 4. How far is your pharmacy from your child’s school?

Question Title

* 5. With this initiative you will be asked to sign a telehealth consent form for your child at the beginning of the school year. Would it be your preference to sign another consent at the time of the virtual visit?

Question Title

* 6. Telehealth in schools is very similar to telehealth with your own primary care doctor; access to reliable technology is key to a successful appointment. Do you have reliable online services where you could log into the appointment? (i.e. smart phone, laptop/computer access)

Question Title

* 7. Additional comments: