Skip to content
Medical Care During COVID Questionnaire
Telehealth refers to the practice of caring for patients remotely when the provider and patient are not physically present with each other. Since the onset of the COVID-19 pandemic, telehealth has been growing in popularity throughout medical practices across the nation. Telehealth can refer to appointments by phone or via videoconferencing software.
Below is a survey made to document your experience receiving healthcare over the past eighteen months. Please answer each question to the best of your ability.
Depending on the results to this survey, we may reach out to certain respondents to get more information. If you are willing to be on this contact list, please submit your name and email address. If not, please skip Questions 1 and 2.
1.
Name
2.
Email
3.
Age
19 or younger
20-29
30-39
40-49
50-59
60 or older
4.
City of residence
5.
State of residence
6.
Race
White
Black or African-American
American Indian or Alaskan Native
Asian
Native Hawaiian or Other Pacific Islander
Multi-racial
Other (please specify)
7.
Education
Some high school but no degree
High school degree or equivalent
Some college but no degree
Associate degree
Bachelor's degree
Graduate degree
8.
Household Income
Less than $25,000
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $124,999
$125,0000 or more
9.
Primary language spoken
10.
If you have been diagnosed with ovarian cancer, how long ago was the initial diagnosis?
Within the last year
Between 1 and 3 years ago
Between 3-5 years ago
Between 5-10 years ago
More than 10 years ago
Not applicable
*
11.
What kind of healthcare coverage do you have?
(Required.)
Medicare
Medicaid
Employer-sponsored
Market-based plan
Military (e.g., TRICARE, CHAMPVA)
Other (please specify)
*
12.
In the past 18 months, has a provider
offered
you an appointment related to any health issue with a doctor, nurse, or other health professional by video or by phone?
(Required.)
Yes via phone only
Yes via video only
Yes via video and/or phone
No
No, but I would have wanted the option
*
13.
In the past 18 months, have you had at least
one appointment with a doctor, nurse, or other health professional
by video or by phone?
(Required.)
No, I did not have any appointments
No, I had my appointment(s) in person
Phone only
Video only
Video and phone
*
14.
In the past 18 months, did you have any medical appointments related to
ovarian cancer
with a doctor, nurse or health professional by video or by phone?
(Required.)
No, I did not have any appointments
No, I had my appointment(s) in person
Phone only
Video only
Video and phone
*
15.
On average, how much time does it take to travel for in-person appointments related to ovarian cancer?
(Required.)
Less than 15 minutes
15-29 minutes
30-44 minutes
45-60 minutes
More than 60 minutes
Not applicable
*
16.
In the past 18 months, have you had at least
one appointment with a
gynecologic oncologist
by video or by phone?
(Required.)
No, I did not have any appointments
No, I had my appointment(s) in person
Phone only
Video only
Video and phone
*
17.
In the past 18 months, have you had
at least one appointment with a mental/behavioral health professional
(therapist, psychiatrist, counselor, etc) by video or by phone?
(Required.)
No, I did not have any appointments
No, I had all my appointment(s) in person
Phone only
Video only
Video and phone appointment(s)
*
18.
In the past 18 months, did you feel prepared and properly informed about any technology, equipment, or paperwork needed to comfortably complete your telehealth visits?
(Required.)
No, I did not have any telehealth appointments
No, I did not get proper guidance for my appointments
I felt prepared and informed for some but not others
Yes, I felt prepared and informed for all of my appointments
Other (please specify)
*
19.
In the past 18 months, how many medical appointments have
you
had with a with a doctor, nurse, or other health professional by video or by phone?
(Required.)
I did not have any appointments/I did not have any appointments by video or phone
1-2
3-5
5+
*
20.
How would you rate your satisfaction from your most recent telehealth appointment (0-10, with 0 being Not Applicable to 10 being the best)?
(Required.)
0
1
2
3
4
5
6
7
8
9
10
*
21.
As best you could tell, were you billed the same for telehealth appointments as you were for regular in-person visits?
(Required.)
Yes
No, the telehealth services were more expensive
No, the in-person visits were more expensive
In some cases, but not others
Not applicable/I did not have any appointments
I don't know
*
22.
In the past 18 months, did you notice any irregularities or surcharges in your medical bill(s) after receiving care? If so, please describe them:
(Required.)
*
23.
How was the
communication and follow-up
with your provider in the telehealth appointments compared to regular in-person visits?
(Required.)
Better
Worse
About the same
Better in some cases, but not others
Not applicable
*
24.
Comparing to in-person visits, how was your overall
experience
with your provider in the telehealth appointments?
(Required.)
Better
Worse
About the same
Better in some cases, but not others
Not applicable
*
25.
Generally, do you prefer telehealth appointments to regular in-person visits?
(Required.)
Yes
No
In some cases, but not others
Not applicable
*
26.
Did you experience any delays in care during these past 18 months, i.e., trouble finding a doctor or setting up an appointment?
(Required.)
No, I did not have any delays in care
Yes, I had trouble finding a doctor only
Yes, I had trouble setting appointments only
Yes, I had trouble finding a doctor and setting appointments
Not applicable
Other (please specify)
27.
Please let us know if there is anything additional you would like to share about your medical care over the past 18 months.
