App Feedback  ·  Trending

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.

Peach theme
formbuilder.ai/f/telehealth-app-video-visit-quality-appointment-booking-feedback-form
Telehealth App Video Visit Quality & Appointment Booking Feedback Form
Date of Your Video Visit
· · ·
Type of Visit
How easy was it to book your app
★★★☆☆
Submit

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.

3 Pages
16 Questions
~5min To complete
Free Included on every plan
Field types Dropdown ×3 choicematrix ×2 Long Text ×2 Date Scale Rating Single Choice Multiple Choice File Upload Star Rating NPS Score Likert Scale Email

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Visit Details & Booking 5 questions
Your Visit & Booking Experience
1 Date of Your Video Visit * Date
2 Type of Visit * Dropdown
3 How easy was it to book your appointment in the app? * Scale Rating
4 Were you able to find an appointment time that worked for you? * Single Choice
5 Rate each step of booking your appointment * choicematrix
Page 2 Video Visit Quality 6 questions
How Was Your Video Visit?
1 Device Used to Join Your Visit * Dropdown
2 How long did you wait for your provider to join? * Dropdown
3 Rate the quality of your video visit * choicematrix
4 Did you experience any of these issues during your visit? * Multiple Choice
5 Tell us more about any technical problems you experienced Long Text
6 Upload a Screenshot of Any Error Message File Upload
Page 3 Overall Experience 5 questions
Your Overall App Experience
1 Overall, how would you rate the app? * Star Rating
2 How likely are you to recommend this app to a friend or family member? * NPS Score
3 My video visit was just as effective as an in-person appointment * Likert Scale
4 What's one thing we could improve about booking or video visits? Long Text
5 Email Address (only if you'd like us to follow up) Email

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

Use this template

Included on every plan. Open in the editor, customize, and publish in minutes.

Use This Template Free Preview the form
Category Feedback & Review
Subcategory App Feedback
Theme Peach
Badge Trending
Price Free
Coding required None

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