Improve Telehealth Booking and Video Visits With Feedback
Gather patient insights on in-app appointment booking, video call quality, wait times, and technical issues to deliver a better telehealth experience.
This Telehealth App Video Visit Quality and Appointment Booking Feedback Form shows virtual care providers how patients experience each step of a remote appointment. It has three sections: booking the visit in the app, the video visit itself, and the overall app experience. Patients rate how easy scheduling was, whether they found a convenient time, and how each booking step performed. They also share which device they used, how long they waited for their provider, how they rate the call quality, and any technical issues they had. They can upload a screenshot of an error message.
The template suits telehealth platforms, digital health startups, hospitals, clinics, and private practices that offer video consultations through a mobile or web app. Product managers, patient experience teams, and IT support staff can use the responses to find friction in the scheduling flow and troubleshoot connection problems by device. They can also measure whether patients feel virtual care is as effective as an in-person appointment.
Rating scales, an NPS-style likelihood-to-recommend question, and an open-ended improvement prompt give you both measurable scores and specific comments. The email field is optional, so patients can ask for a follow-up without having to identify themselves, which encourages honest answers. Customize the questions, add your branding, and share the form after each visit to improve booking, reduce technical issues, and raise patient satisfaction with your telehealth service.
Questions in this template
Free templateThe exact questions included — customize any of them to fit your needs.
How to use this template
Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.
- Ready-to-use structure — pre-configured fields out of the box
- Applied "Peach" theme — fonts, colors, and layout already set
- Mobile-responsive — works on every device without extra configuration
- Fully editable with drag-and-drop — change anything in seconds
- Included on every plan — try it free for 7 days
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