2900-0876-AB2 Telemedicine Appointment Scheduling

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1 ), or texting 838255, or visiting htt(;1s://www.veteranscrisisline.net. If you are homeless or
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0MB N umber: 2900-0876
Expiration: 09/30/2023
Estimated Burden: 2 minutes

Help us serve you better
We want to hear about your recent experience scheduling a Telehealth
appointment. By indicating how much you agree or disagree with the
statements below, you directly help us improve VA services.
This survey should take you approximately 2 minutes to complete.

I was given a choice between having my appointment in-person at a VA facility or through
Telehealth. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

I got my appointment on a date and time that worked for me. Required
Strongly Disagree

1

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

2

3

4

5

When scheduling my appointment, I was treated with respect. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

It was clear before my appointment what to expect. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

I trust Telehealth as part of my overall VA healthcare. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree