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Telehealth survey template

Find out if video visits work, for the patient on the other end

Four questions for right after a video visit: how easy it was to join, what went wrong with the call, how comfortable patients felt on camera and how they want to be seen next time. Use it as it is or change any question, and Usertick reads every response for urgency and customer risk.

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What this telehealth survey tells you

A telehealth survey asks patients about the video visit itself: getting into the call, whether the sound and the picture held up, and how it felt to talk to a provider through a screen. This template asks four questions in under a minute and ends with the answer your schedule needs, video or in person next time.

It is written for the minutes after the call ends. Put the link in the message your video or scheduling system sends after the visit, or send it by Usertick email to the patients seen that day. When patients join from a page on your own website, the same survey can open there as a popup.

Results shows the ease score and the share who found joining easy, the share of each technical problem with the typed Other answers listed, and the split between video, in person and no preference. Each response gets an urgency and a customer risk reading, so the visits that need a call back are easy to find in the inbox.

In an emailAs a linkOn your websiteAs a conversation
Questions
4
Time to answer
Under a minute
Written for
Right after the video visit ends, by link or email
Plans
Every plan, the free plan included

See it on every channel

The same template on your website, behind a link, in an email and as a conversation.

In an email

Send it from Usertick to a contact list, with the first question inside the email. A tap on an answer opens the rest of the survey with that answer already kept. Usertick sends 50 emails a month on the free plan, or connect your own sender.

The 4 questions, one by one

What each question asks, why it is there, what it shows you and what to change.

Question 1 of 4 · Customer effort

How easy was it to join your video visit?

Why ask it
Joining is where a video visit fails first: a link that won't open, a browser that asks for the camera, a waiting room that never moves. A 1 to 7 effort scale from very difficult to very easy measures that friction directly.
What you learn
The average on the 1 to 7 scale and the share who found it easy, with a hard-to-easy bar, against the period before. Select the lowest scores to see which technical problems those patients picked.
Make it yours
Keep it first, so in the email patients tap a score inside the message and the rest of the survey opens with it kept.
Question 2 of 4 · Multiple choice · Optional

Did you have any technical problems?

Why ask it
When the ease score is low, this question says why. Patients can pick more than one problem, and the write-in Other catches what the list misses, such as a camera that wouldn't switch on or a call that started late.
What you learn
Bars with the share and count of each problem, every typed Other answer listed beside the chart, and the stacked shares over time, so you can see whether a change to your video platform helped.
Make it yours
Keep No, everything worked as the first option, and add the problems your front desk hears about on the phone.
Question 3 of 4 · Big scale

How comfortable did you feel talking to the provider by video?

Why ask it
A call can work perfectly and still feel wrong for the conversation. Comfort on video decides whether patients accept a video slot the next time one is offered.
What you learn
The average and a column per step from 1 to 10, compared with the period before. Select the low columns to see whether those patients also had technical problems.
Make it yours
Read it beside the last question: low comfort together with a preference for in person shows which visits to keep in the office.
Question 4 of 4 · Multiple choice

For your next visit, which would you prefer?

Why ask it
It turns the visit into a scheduling answer: how many patients want video again, how many want to come in and how many don't mind.
What you learn
A donut with the share and count of each choice, and the stacked shares over time as your video service settles in.
Make it yours
Share the split with whoever plans the schedule, and select An in-person visit to see whether those patients had trouble joining.

What the answers show

Results turns each question into numbers you can follow week by week.

How easy was it to join your video visit?

The average on its own scale and the share who found it easy, against the period before and by device.

Did you have any technical problems?

The share of each answer with its count. Select an answer to narrow the whole page to those people and read what else they said.

For your next visit, which would you prefer?

The share of each answer with its count. Select an answer to narrow the whole page to those people and read what else they said.

Use this template in four steps

From the template to the first answers.

  1. 1

    Open the template

    Sign up free and pick Telehealth visit in the template gallery. It opens in a matching style, ready to change.

  2. 2

    Make the questions yours

    Reword any question, change the options, and add logic or more questions.

  3. 3

    Choose where it runs

    Show it on your website, send it by email, share its link and QR code, or switch it to a conversation.

  4. 4

    Publish and read the answers

    Answers arrive in Results and the inbox as people send them, each written one read and filed by Usertick.

Tips for this survey

Small choices that keep people answering and the answers useful.

  1. 01

    Ask within the hour

    Send the link while the call is fresh, so patients still remember whether the sound dropped or the link failed.

  2. 02

    Keep the call apart from the care

    Ask about joining, sound, picture and comfort, and leave symptoms and diagnoses out. Usertick's terms don't allow medical details in surveys, and Usertick doesn't sign business associate agreements.

  3. 03

    Send call problems to one person

    On every plan, a workflow can post every response that picked The connection dropped to Slack or Microsoft Teams, so whoever runs the video platform sees it the same day.

  4. 04

    Add an open question when needed

    When the Other answers pile up, add an optional text question at the end. Usertick reads each written answer and files it under a category such as app and online access.

Customer effort scorePatient satisfaction surveysEmail surveysTelehealth questions

More customer effort templates and questions

Templates like this one, and single questions from the library to add to it.

Templates

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Customer effortPatient portalMeasure how easy your patient portal is to use and whether people could finish what they came to do. Show it after a patient logs out.
Customer effortLab testMeasure the lab experience from booking to results, including waits at the lab. Send it once results are released.
Customer effortVaccination clinicLearn how easy it was to get an appointment, how long people waited and whether aftercare information was clear. Send it the day after the appointment.
Customer effortPrescription refillMeasure how easy prescription refills are to request and how long they take to be ready. Send it once the refill is picked up or delivered.

Questions from the library

Browse the question library
  1. How easy was it to join the video call?Customer effort · Telehealth
  2. Which issues did you have on the call?Multiple choice · Telehealth
  3. How confident are you in the outcome of the call?Big scale · Telehealth
  4. How often do you come in for a check?Dropdown · Long term care check ins
  5. How easy is it to fit these visits around your life?Customer effort · Long term care check ins
  6. Do you see the same person each time?Yes / No · Long term care check ins

Frequently asked questions

As soon as the video visit ends. Usertick sends email now or at a scheduled time, but it doesn't send on its own when a call ends, so the quickest route is the survey link in the message your video or scheduling system already sends.

Few enough to answer on the device the patient just used for the call. This template asks four and takes under a minute.

Yes. The survey link opens in any phone browser, and the email puts the first question inside the message. Usertick doesn't show surveys inside a phone app, so a telehealth app opens the survey's link instead.

Look at their ease and comfort scores first. If they struggled to join, fix the call; if they felt uncomfortable on camera, keep those visit types in the office.

Yes. Run this survey for video visits and an appointment survey for office visits, then put both on one dashboard. Free includes one dashboard, Starter three and Pro and up unlimited.

Yes. Every template comes with every plan, the free plan included, and the free plan covers 150 responses a month across your surveys.

Yes. The template becomes your own survey, so reword any question, add or remove questions, and change the options and the logic. The gallery stays as it is.

Yes, from Starter. The template is written in US English. Add languages by hand or with AI translation, and each person sees the survey in their browser's language.

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