Blog
Podcast
Contact Us
Bill Pay
Careers
407-370-0111
search

Search for:

Programs & Services
About Us
Admissions

Telehealth Satisfaction SurveyUHSDEV2021-04-07T16:10:30-04:00

Telehealth Satisfaction Survey

Telehealth Satisfaction Survey

Patient Name*
First Last
Date Completed*
MM slash DD slash YYYY
1. Your overall telemedicine experience*
- Excellent
- Very Good
- Good
- Fair
- Poor
2. Your telemedicine physician*
- Excellent
- Very Good
- Good
- Fair
- Poor
3. The availability of your telemedicine physician.*
- Excellent
- Very Good
- Good
- Fair
- Poor
4. The amount of time your telemedicine physician spent with you.*
- Excellent
- Very Good
- Good
- Fair
- Poor
5. The ability to develop a relationship with your telemedicine physician.*
- Excellent
- Very Good
- Good
- Fair
- Poor
6. Orientation to the telemedicine process.*
- Excellent
- Very Good
- Good
- Fair
- Poor
7. Your level of comfort with the telemedicine process.*
- Excellent
- Very Good
- Good
- Fair
- Poor
8. Your privacy with the telemedicine process.*
- Excellent
- Very Good
- Good
- Fair
- Poor
9. Your telemedicine experience was free of distractions.*
- Definitely Agree
- Somewhat Agree
- Somewhat Disagree
- Definitely Disagree
10. Your telemedicine experience was free of technical issues.*
- Definitely Agree
- Somewhat Agree
- Somewhat Disagree
- Definitely Disagree
11. Would you participate in telemedicine in the future?*
- Definitely Agree
- Somewhat Agree
- Somewhat Disagree
- Definitely Disagree
11. Would you recommend using telemedicine to friends or family?*
- Definitely Agree
- Somewhat Agree
- Somewhat Disagree
- Definitely Disagree
Comments
Program Type*
- PHP-5 day
- Day IOP-3 day
- Evening IOP
- Adolescent IOP

We’re Always Here to Help

Licensed mental health professionals are available 24 hours a day, 7 days a week to assist you or your loved one. To schedule a no-cost assessment or for more information, please call 407-370-0111.

Telehealth Satisfaction Survey

Physicians are on the medical staff of Central Florida Behavioral Hospital, but, with limited exceptions, are independent practitioners who are not employees or agents of Central Florida Behavioral Hospital. The facility shall not be liable for actions or treatments provided by physicians. Model representations of real patients are shown. TRICARE® is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved. There are risks associated with any treatment procedure and individual results may vary. Please consult the dedicated professionals within the ECT program at Central Florida Behavioral Hospital to assess if you are a candidate for ECT treatment. Our medical staff will also consult with you on the risks and benefits of ECT treatment if you are a suitable candidate.

HIPAA Notice
Nondiscrimination Notice
Standard Services
Language Assistance
Terms of Use
Privacy Policy
Financial Information
Visitation Rights
Sitemap
Download Adobe Acrobat Reader
No Surprises Act
Accessibility Statement
Your Privacy Choices

© Central Florida Behavioral Hospital. All rights reserved.

Generic selectors

Exact matches only

Search in title

Search in content

Post Type Selectors