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.
What's Included
AI-Powered Questions
Intelligent follow-up questions based on responses
Automated Analysis
Real-time sentiment and insight detection
Smart Distribution
Target the right audience automatically
Detailed Reports
Comprehensive insights and recommendations
Template Overview
28
Questions
AI-Powered
Smart Analysis
Ready-to-Use
Launch in Minutes
This professionally designed survey template helps you gather valuable insights with intelligent question flow and automated analysis.
Sample Survey Items
Q1
Chat Message
Welcome to this survey about your experiences with teletherapy (therapy conducted by video, phone, or text/chat). This survey takes approximately 6–8 minutes to complete.
Your participation is entirely voluntary, and you may stop at any time. There are no right or wrong answers — we are interested only in your honest opinions and experiences. All responses are confidential, will be anonymized, and reported only in aggregate.
By continuing, you agree to participate in this research.
Q2
Multiple Choice
Have you ever participated in a teletherapy session (e.g., by video, phone, or text/chat)?
Yes
No
Q3
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
Other (please specify)
Q4
Opinion Scale
How likely are you to try teletherapy in the next 3 months?
Range: 1 – 7
Min: Very unlikelyMid: NeutralMax: Very likely
Q5
Dropdown
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
Q6
Dropdown
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
Q7
Multiple Choice
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)
Q8
Dropdown
Which device did you primarily use for teletherapy in the past 3 months?
Smartphone
Laptop or desktop computer
Tablet
Other (please specify)
Q9
Opinion Scale
How would you rate the overall audio and video connection quality during your teletherapy sessions in the past 3 months?
Range: 1 – 7
Min: Very poorMid: NeutralMax: Excellent
Q10
Opinion Scale
How comfortable did you feel sharing personal information during your teletherapy sessions in the past 3 months?
Range: 1 – 7
Min: Not at all comfortableMid: NeutralMax: Very comfortable
Q11
Opinion Scale
How concerned were you about the privacy of your teletherapy sessions in the past 3 months?
Range: 1 – 7
Min: Not at all concernedMid: NeutralMax: Extremely concerned
Q12
Chat Message
The following questions ask how things have changed since you started teletherapy. Please answer based on your overall experience.
Q13
Opinion Scale
Since starting teletherapy, how have your anxiety or stress levels changed?
Range: 1 – 7
Min: Much worseMid: NeutralMax: Much improved
Q14
Opinion Scale
Since starting teletherapy, how has your overall mood changed?
Range: 1 – 7
Min: Much worseMid: NeutralMax: Much improved
Q15
Opinion Scale
Since starting teletherapy, how has your ability to cope with daily challenges changed?
Range: 1 – 7
Min: Much worseMid: NeutralMax: Much improved
Q16
Opinion Scale
Since starting teletherapy, how has the quality of your personal relationships changed?
Range: 1 – 7
Min: Much worseMid: NeutralMax: Much improved
Q17
Opinion Scale
Overall, how satisfied are you with your teletherapy experience?
Range: 1 – 7
Min: Not at all satisfiedMid: NeutralMax: Extremely satisfied
Q18
Opinion Scale
How likely are you to recommend teletherapy to someone who could benefit from therapy?
Range: 1 – 7
Min: Not at all likelyMid: NeutralMax: Extremely likely
Q19
Multiple Choice
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
Q20
Long Text
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.
Max chars
Q21
AI Interview
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.
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 7
Q22
Dropdown
What is your age?
Under 18
18–24
25–34
35–44
45–54
55–64
65 or older
Prefer not to say
Q23
Multiple Choice
Which best describes your gender?
Woman
Man
Non-binary
Another identity (please describe below)
Prefer not to say
Q24
Long Text
If you selected 'Another identity' above, please describe your gender here.
Max chars
Q25
Dropdown
Where do you currently live?
North America
Europe
Latin America & Caribbean
Africa
Middle East
Asia
Oceania
Prefer not to say
Q26
Dropdown
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
Q27
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 or health
Retired
Homemaker or caregiver
Prefer not to say
Q28
Chat Message
Thank you for completing this survey. Your responses have been recorded and will be kept confidential. Your feedback helps improve teletherapy services for everyone.
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