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Virtual Consultation Satisfaction Survey
First Name
*
Last Name
*
Did you experience any technical problems?
*
No
Yes
Please explain the technical problem:
*
Did the ICD Virtual Consultant sufficiently answer all your questions in the time allowed?
*
Yes
No
Please explain why:
*
How well does each of the following words describe your Virtual Consultant?
*
How well does each of the following words describe your Virtual Consultant?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Attentive Listener
How well does each of the following words describe your Virtual Consultant?: Attentive Listener (Strongly Disagree)
Attentive Listener (Disagree)
Attentive Listener (Neutral)
Attentive Listener (Agree)
Attentive Listener (Strongly Agree)
Friendly
Friendly (Strongly Disagree)
Friendly (Disagree)
Friendly (Neutral)
Friendly (Agree)
Friendly (Strongly Agree)
Patient
Patient (Strongly Disagree)
Patient (Disagree)
Patient (Neutral)
Patient (Agree)
Patient (Strongly Agree)
Courteous
Courteous (Strongly Disagree)
Courteous (Disagree)
Courteous (Neutral)
Courteous (Agree)
Courteous (Strongly Agree)
Knowledgeable
Knowledgeable (Strongly Disagree)
Knowledgeable (Disagree)
Knowledgeable (Neutral)
Knowledgeable (Agree)
Knowledgeable (Strongly Agree)
How was your overall experience with Virtual Consultations?
*
Very Good
Good
Fair
Poor
Very Poor
CGFNS or ICD?
ICD
Would you recommend the Virtual Consultation service?
*
No
Yes
Reason
What did you like about the Virtual Consultation?
*
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