Virtual Care Workflow Assessment Evaluation Form

Virtual Care Workflow Assessment Evaluation Form
Please complete the evaluation to assess the virtual care workflow.
Evaluator's Full Name
First NameLast Name
Evaluator's Email Address
example@example.com
Date of Evaluation
MonthDayYear
Date
Please rate the following aspects of the virtual care workflow:
Ease of Access to Virtual Care Platform

1
2
3
4
5
1 is , 5 is Best
Effectiveness of Communication Tools

1
2
3
4
5
1 is , 5 is Best
Timeliness of Virtual Care Delivery

1
2
3
4
5
1 is , 5 is Best
Overall Satisfaction with Virtual Care Workflow

1
2
3
4
5
1 is , 5 is Best
Comments or Suggestions
Should be Empty:

Select theme:

Please rate the following aspects of the virtual care workflow: