Virtual Clinic Feedback Survey
We value your feedback on your recent virtual clinic visit. Please take a few moments to share your experience and help us improve our service.
Overall, how satisfied were you with your virtual clinic visit?
*
1
2
3
4
5
How easy was it to access your virtual appointment?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
How would you rate the clarity of communication with your provider?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Did you experience any technical issues during your virtual visit?
*
No issues
Minor issues
Major issues
How comfortable did you feel discussing your concerns virtually?
*
Not Comfortable
1
2
3
4
Very Comfortable
5
1 is Not Comfortable, 5 is Very Comfortable
How likely are you to recommend our virtual clinic to others?
*
Not Likely
1
2
3
4
Extremely Likely
5
1 is Not Likely, 5 is Extremely Likely
How would you rate your provider's professionalism?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
How well did the virtual clinic meet your needs today?
*
Not at all
1
2
3
4
Completely
5
1 is Not at all, 5 is Completely
What did you like most about your virtual visit?
Do you have any suggestions for improving our virtual clinic experience?
Submit Feedback
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