2900-AB3 Telemedicine At Home or Mobile Appointment

The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1 ), or texting 838255, or visiting htt(;1s://www.veteranscrisisline.net. If you are homeless or
at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting htt(;1s://www.va.gov/HOMELESS/.

0MB N umber: 2900-0876
Expiration: 09/30/2023
Estimated Burden: 2 minutes

Help us serve you better
Tell us about your experience during your recent Telehealth appointment.
By indicating how much you agree with the statements below, you directly help
us improve VA healthcare.
This survey should take you approximately 2 minutes to complete.

Connecting to my VA Video Connect appointment was easy. Required
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The VA staff gave me information about connecting to my video Telehealth appointment.
Strongly Disagree

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My provider listened to me during the appointment in a caring manner. Required
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My provider explained things to me in a way that was easy to understand. Required
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After my appointment, I was clear about my next steps of care. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree