<p>Most telehealth studies have focused on caregiver satisfaction with autism spectrum disorder (ASD) assessments. Few have examined caregiver perceptions of direct-to-home telehealth evaluations for children with developmental concerns broader than ASD. The current study explored caregiver perspectives (<i>N</i> = 439) of the telehealth process, including technology barriers and satisfaction with remote delivery of diagnostic feedback, before and after a 24-month tele-assessment, in children from four outcome groups (ASD, Speech-Language Concerns, Other Developmental Concerns, and No Concerns). The results indicated overall high levels of caregiver satisfaction and acceptability across all outcome groups, although the ASD group had a lower rate (89%) than the other groups (99–100%) of rating “very true” to feeling like a valued partner in the tele-assessment, the evaluation meeting their needs (89% v. 94–99%), and understanding the results (86% v. 96–98%). Families of children with Speech-Language Concerns, the largest diagnostic outcome group, were highly satisfied and found tele-assessment acceptable. There were no differences in caregiver perceptions of the tele-assessment process based on whether they had prior concerns about their child or not. Few technology barriers were reported by any groups and socio-demographic variables (race, ethnicity, socioeconomic status, travel distance from medical center) were not associated with differences in technology access or satisfaction with the tele-evaluations. Overall, these findings support the use of tele-assessment for a wide range of children whose families may not have access to in-person assessment services, as well as suggest ways to further improve remote models of care.</p>