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Telehealth Experience Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
What is your age?
Please select the age range that corresponds to your current age.
18-30
31-45
46-60
61-75
76+
2
What is your gender?
Please select your gender.
Male
Female
Other
3
How long has it been since your stroke?
Please select the time period since your stroke.
Less than 6 months
6 months to 1 year
1-5 years
More than 5 years
4
Have you had any prior experience with telehealth?
Please indicate if you have had any experience with telehealth before.
Yes
No
5
How satisfied are you with the telehealth sessions?
Please rate your satisfaction with the telehealth sessions.
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
6
Did you find the telehealth sessions beneficial?
Please indicate if you found the telehealth sessions beneficial.
Yes
No
7
How likely are you to recommend telehealth to others?
Please rate how likely you are to recommend telehealth to others.
8
What aspects of telehealth sessions do you find most helpful?
Please select all that apply.
Convenience
Flexibility
Cost-effectiveness
Quality of care
None of the above
9
Is there anything you would like to change or improve about the telehealth sessions?
Please provide your feedback or suggestions.
10
Overall, how would you rate your experience with telehealth?
Please rate your overall experience with telehealth sessions.
Excellent
Good
Average
Poor
Very poor
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