Telehealth Survey

Question Title

1. Are you a current patient at the RMMSC at University of Colorado Hospital (UCHealth)?

Yes

No

Question Title

2. Do you live in Colorado?

Yes

No

Question Title

3. How far do you currently travel to get to your appointments at UCH Anschutz Medical Campus?

Less than 10 miles

11 to 50 miles

51 to 100 miles

Greater than 100 miles

Question Title

4. How interested would you be in having home-based telemedicine?

Very interested

Somewhat interested

Unsure/neutral

Not very interested

Not interested at all

Question Title

5. What is your primary insurance?

Medicare

Medicaid

Tri-Care

Insurance through my/spouse’s employer

Other (please specify)