Teletherapy Access, Experience & Outcomes Assessment
Evaluates patient access barriers, session comfort, perceived therapeutic outcomes, and format preferences for teletherapy. Designed for healthcare organizations and telehealth platforms seeking to improve virtual care delivery.
샘플 질문
템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.
Have you ever participated in a teletherapy session (e.g., by video, phone, or text/chat)?
- Yes
- No
What are the main reasons you have not used teletherapy so far? Select all that apply.
- I prefer in-person therapy
- I'm not sure how to get started
- Privacy concerns at home or work
- Not comfortable with technology
- Cost or insurance concerns
- No suitable device or internet connection
- Teletherapy not available with my provider
- Concerns about quality or effectiveness
- I don't need therapy right now
- Other (please specify)
Approximately how many teletherapy sessions have you had in the past 3 months?
- 0 (none in this period)
- 1–2
- 3–5
- 6–10
- 11–20
- More than 20
How would you rate the overall audio and video connection quality during your teletherapy sessions in the past 3 months?
The following questions ask how things have changed since you started teletherapy. Please answer based on your overall experience.
Overall, how satisfied are you with your teletherapy experience?
Based on your responses in this survey, what could make teletherapy work better for you? Please share any additional thoughts or feelings about your experience.
What is your age?
- Under 18
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65 or older
- Prefer not to say
Thank you for completing this survey. Your responses have been recorded and will be kept confidential. Your feedback helps improve teletherapy services for everyone.
How likely are you to try teletherapy in the next 3 months?
When was your most recent teletherapy session?
- Within the past week
- 1–2 weeks ago
- 3–4 weeks ago
- 1–2 months ago
- 3 months ago or longer
How comfortable did you feel sharing personal information during your teletherapy sessions in the past 3 months?
Since starting teletherapy, how have your anxiety or stress levels changed?
How likely are you to recommend teletherapy to someone who could benefit from therapy?
We'd like to understand your teletherapy experience in more depth. An AI moderator will ask a couple of brief follow-up questions based on your earlier responses.
Which best describes your gender?
- Woman
- Man
- Non-binary
- Another identity (please describe below)
- Prefer not to say
Which formats have you used for teletherapy in the past 3 months? Select all that apply.
- Video call
- Phone call
- Text/chat-based
- Email-based
- Online group sessions
- Other (please specify)
How concerned were you about the privacy of your teletherapy sessions in the past 3 months?
Since starting teletherapy, how has your overall mood changed?
For your future therapy sessions, which format would you prefer?
- Mostly teletherapy
- Mostly in-person
- A mix of both
- No preference
- Not planning to continue therapy
If you selected 'Another identity' above, please describe your gender here.
Which device did you primarily use for teletherapy in the past 3 months?
- Smartphone
- Laptop or desktop computer
- Tablet
- Other (please specify)
Since starting teletherapy, how has your ability to cope with daily challenges changed?
Where do you currently live?
- North America
- Europe
- Latin America & Caribbean
- Africa
- Middle East
- Asia
- Oceania
- Prefer not to say
Since starting teletherapy, how has the quality of your personal relationships changed?
What is the highest level of education you have completed?
- Less than high school
- High school or equivalent
- Some college or associate degree
- Bachelor's degree
- Graduate or professional degree
- Prefer not to say
What is your current employment status?
- Employed full-time
- Employed part-time
- Self-employed
- Student
- Unemployed and seeking work
- Not working due to disability or health
- Retired
- Homemaker or caregiver
- Prefer not to say
포함된 기능
AI 후속 질문
정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.
주의력 확인 장치
성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.
AI가 작성한 문안
문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.
자동 리포트
응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.
다른 서비스와 비교
다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.
이 템플릿을 선택하는 이유
- Includes an adaptive AI follow-up interview that lets patients elaborate on their teletherapy experience in their own words, beyond fixed-choice answers
- Covers the full journey from access barriers and format/device usage to session comfort, privacy concerns, and connection quality
- Tracks perceived therapeutic outcomes (anxiety, mood, coping, relationship quality) with dedicated before/after opinion-scale items, plus overall satisfaction and likelihood to recommend
- Closes with an open-text question asking what could make teletherapy work better, giving healthcare orgs qualitative improvement input alongside automated quality scoring and auto-generated reports
Jotform
600+ Healthcare Assessment FormsThis is a broad directory/category page listing hundreds of healthcare assessment form templates rather than a single ready-to-field teletherapy experience survey. It's useful as a starting point for generic intake or assessment forms, but nothing here is purpose-built around teletherapy access, comfort, or outcomes. Teams would need to build and customize a teletherapy-specific instrument from a generic form base.
잘하는 점
- Very large, categorized library of healthcare-related form templates
- Familiar drag-and-drop form builder widely used by clinics and healthcare admins
- Likely supports HIPAA-friendly form options common across Jotform's healthcare template set
아쉬운 점
- No teletherapy-specific template covering access barriers, session comfort, or therapeutic outcome tracking — this is a generic form category, not a fielding-ready survey
- Static form fields only, with no adaptive AI follow-up probing or voice AI interview capability
- No automated per-response quality scoring or auto-generated analytical reporting
설문을 공개할 준비가 되셨나요?
이 템플릿을 편집기에서 열어 보세요. 첫 응답자가 보기 전에 모든 부분을 원하는 대로 바꿀 수 있습니다.