The advantages of telephone consultations for patients with acute stroke syndromes are history of use, simplicity, availability, portability, short consultation time, and facile implementation. The favorable aspects of telemedicine consultations are high accuracy, reliability, efficacy, and effectiveness, the growing technological sophistication of the offerings and features, and the high grade of recommendation. Between the two modalities, telemedicine is optimal for assessing patients with acute stroke and superior to telephone-only evaluations. Telephone consultations can serve as an adequate ancillary, adjunctive, supplemental, or back-up modality for a telestroke network. With recent advances in one-way/two-way video and teleradiology features adapted to Smartphones, the dividing line between "telephone" and "telemedicine" consultations for acute stroke is indistinct. Telestroke providers prefer a figurative "tool belt" of technologies available to adapt to individual consultation requirements.