Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Hudson Valley Veterans' Task Force Healthcare Committee Voluntary Survey
This form is to be used by any veteran who either receives health care services through the VA at Castle Point and/or Montrose or any of the area CBOCS.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Are you receiving healthcare services from the VA at Castle Point or Montrose or one of the CBOCs in the Hudson Valley system? If no or rejected, please scroll to the bottom of the survey and complete the last question.
*
Yes
No
In process
Rejected
If yes, what campus (Castle Point, Montrose) or CBOC do you use?
Your answer
If yes, do have a primary doctor in the VA?
Yes
No
Unsure
Clear selection
How are your appointments made?
My Healthevet
VA Staff
Other
Do you use My Healthevet for other needs? Ck as many answers as apply.
Yes
No
Don't know how to use it.
I don't know what My Healthevet is!?
Other:
Have you had any problems making or changing appointments when needed?
Yes, all the time
More than half the time
About half the time
Occasionally
No, I have no problems
Clear selection
Do you receive reminder notices from the VA? Check all that apply.
Email
Text
Phone call
Postcard
Other
Have you received any support in how to use My Healthevet? Check all that apply.
Training from staff either individually or in a class
Tech support via phone from staff
No one ever offered to teach me how to use My Healthevet!
Other
Are there other issues that you have experienced that you believe need to be addressed with the administration?
Your answer
If you receive care from any of the VA facilities, do you have transportation to and from those appointments?
Yes
Most of the time
About half of the time
Some of the time
No
Clear selection
If your answer to #1 was "no" and you have not registered with the Hudson Valley VA Healthcare system, why not?
Your answer
If your answer to #1 was "rejected", what were the reasons given for your rejection?
Your answer
If you would like for someone to contact you, please leave your name, what county you live in and a good phone number and email and if you prefer to be contacted by one or the other.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
