Introduction: Chat-based telemedicine has become a popular method for consulting cognitive complaints in Indonesia, especially during the COVID-19 pandemic. This study explores patient characteristics and their correlation with physicians’ decisions on treatment and referral. Methods: A retrospective cross-sectional study analyzed secondary data from patient chat databases on Indonesian telemedicine platforms between March 2020 and December 2021. Bivariate and multivariable analysis were conducted. Results: Out of 1,016 patients (0.4% of 2,199,527 users), most were females under 40. Clinicians were more likely to provide pharmacological treatment for patients aged ≥60, females, or those with forgetfulness complaints or a history of cognitive disorders (p < 0.01). Referral likelihood increased when caregivers filed complaints or prior diagnoses existed (p < 0.01). Discussion: Clinicians’ decisions in telemedicine were influenced by age, gender, complaint type, and caregiver involvement. Further research is needed to improve telemedicine for cognitive care. © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).