2900-0876-AB4 Telemedicine Clinic 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 Number: 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 at
Atlanta VA Clinic.
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.

After I checked in for my appointment, the clinic staff explained how the video Telehealth
technology would work in a way that was easy to understand. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

My provider explained things to me in a way that was easy to understand. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

My provider listened to me during the appointment in a caring manner. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

I was able to see the provider clearly by video. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

I was able to hear the provider clearly by video. Required