The Telehealth Service Feedback Form Template by WPForms helps online therapists gather useful feedback regarding their telehealth services through a simple form that deploys a Likert scale for measuring opinions.
How Does the Telehealth Service Feedback Form Template Work?
The Telehealth Service Feedback Form Template requires the WPForms Pro License and the Survey and Polls Addon to create a survey form that collects data and allows viewing responses in visual charts and graphs. Fields include:
- Personal Information (Optional):
- Full Name: Gathers the patient’s name to personalize the feedback process.
- Email Address: Collects the patient’s email for any necessary follow-up.
- Date of Appointment: Helps correlate feedback with specific telehealth sessions.
- Provider’s Name: Identifies which provider the feedback is about.
- Service Evaluation:
- Likert Scale: A series of questions using a Likert scale to rate various aspects of the service, such as;
- Ratings: Ease of scheduling, communication quality, technical expertise, and overall satisfaction to quantify patient experience.
- Open-Ended Feedback:
- What did you like most about your telehealth experience? An open-ended question inviting positive feedback to understand strengths.
- What aspects of the telehealth service can be improved? Another open-ended question aimed at identifying areas for enhancement.
- Consent to Use Feedback: Secures permission to utilize the patient’s feedback for service improvement.
Sign up with WPForms today and access the Telehealth Service Feedback Form Template. It is perfect for healthcare providers, clinics, and organizations offering telehealth services and requiring an efficient feedback collection system.
