Telephone Appointment Patient Survey

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* 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)

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* 2. Did you feel your health concern needed to be addressed within the same day or next day?

Yes

Wasn't sure

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* 3. Did you experience any issues or concerns about privacy or security in relation to your telephone appointment?

Yes (please specify)

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* 4. Did you experience any difficulty hearing/understanding your provider's instructions or have connection issues related to poor cell phone reception?

Yes (please provide details)

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* 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)

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* 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

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* 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

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* 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

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* 9. Thinking of your most recent telephone appointment:

What was done particularly well:

What could be done to improve your experience:

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* 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

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* 11. In general, how would you rate your overall health?

Excellent

Very Good

Good

Fair

Poor