2900-0876-AB6 Telemedicine Store Forward Results

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1 ), or texting 838255, or visiting htt(;1s://www.veteranscrisisline.net. If you are homeless or
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0MB N umber: 2900-0876
Expiration: 09/30/2023
Estimated Burden: 2 minutes

Help us serve you better
We want to hear about your recent experience receiving the results of health
information or images using Store and Forward Telehealth services. By
indicating how much you agree or disagree with the statements below, you
directly help us improve VA services.
This survey should take you approximately 2 minutes to complete.

I received my exam results in a timely manner. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

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4

5

The VA provider told me my exam results in a caring manner. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

The exam results were explained to me in terms I could understand. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

When I needed a follow-up appointment, it was scheduled for me in a timely manner.
Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

I felt clear on my next steps after seeing my exam results. Required
Strongly Disagree

Disagree

Neither Agree nor

Agree

Strongly Agree