Telehealth No-Show Follow-Up Survey Form
Telehealth No-Show Follow-Up Survey Form
Gathers reasons patients missed a telehealth appointment to reduce future no-shows and improve virtual visit accessibility.
We missed you at your virtual appointment. Please help us understand what happened so we can make things easier.
Patient name *
Your answer
Missed appointment date
Primary reason you missed the visit
Technology issue
Forgot
Schedule conflict
No longer needed care
Privacy concerns at home
Insurance/cost concern
Other
Technology issue details
Did you receive reminder notifications?
Preferred reminder channel going forward
Would you prefer an in-person visit instead?
+ 6 more questions
About this template
Gathers reasons patients missed a telehealth appointment to reduce future no-shows and improve virtual visit accessibility.
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