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Teletherapy/Telehealth Patient Survey: Access & Outcomes

Assess teletherapy access, comfort, satisfaction, and outcomes for online therapy (video or phone). Telehealth patient survey template; 6-8 minutes.

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Sample Survey Items

Q1
multiple choice
Have you ever had a teletherapy session (by video or phone)?
  • Yes
  • No
Q2
multiple choice
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
Q3
opinion scale
How likely are you to try teletherapy in the next 3 months?
Q4
numeric
How many teletherapy sessions have you had in the past 3 months?
Q5
date
When was your most recent teletherapy session?
Q6
multiple choice
Which formats have you used for teletherapy in the past 12 months? Select all that apply.
  • Video call
  • Phone call
  • Text/chat-based
  • Email-based
  • Online group sessions
Q7
dropdown
Which device did you primarily use for teletherapy in the past 3 months?
Q8
rating
Overall audio/video connection quality during teletherapy in the past 3 months.
Q9
opinion scale
How comfortable did you feel sharing personal information during teletherapy in the past 3 months?
Q10
opinion scale
How concerned were you about privacy during your teletherapy sessions in the past 3 months?
Q11
matrix
Compared with before you started teletherapy, how have the following changed?
Q12
multiple choice
For your future therapy, which option would you prefer?
  • Mostly teletherapy
  • Mostly in-person
  • A mix of both
  • No preference
  • Not planning therapy
Q13
multiple choice
Attention check: To confirm attention, please select “Agree.”
  • Strongly disagree
  • Disagree
  • Neutral
  • Agree
  • Strongly agree
Q14
dropdown
What is your age?
Q15
multiple choice
Which best describes your gender?
  • Woman
  • Man
  • Non-binary
  • Another identity (self-describe)
  • Prefer not to say
Q16
short text
Please self-describe your gender.
Max 100 chars
Q17
dropdown
Where do you currently live?
Q18
dropdown
What is the highest level of education you have completed?
Q19
multiple choice
What is your current employment status?
  • Employed full-time
  • Employed part-time
  • Self-employed
  • Student
  • Unemployed and seeking work
  • Not working due to disability/health
  • Retired
  • Homemaker/caregiver
  • Prefer not to say
Q20
long text
What could make teletherapy work better for you?
Max 600 chars
Q21
ai interview
AI Interview: 2 Follow-up Questions on Teletherapy
AI Interview
Q22
chat message
Thank you for completing the survey. Your responses have been recorded.

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Teletherapy/Telehealth Patient Survey: Access & Outcomes - Survey Template | QuestionPunk