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Barrier Survey for Referring Partners
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1.
What is your name/ clinic name?
(Required.)
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2.
Are any of the following barriers preventing you from referring clients to the Alzheimer Society of Newfoundland and Labrador?
(Required.)
COVID - 19 has reduced the frequency of in-person medical appointments
I am unfamiliar with the referral process
The referral process takes time I do not have
My clients do not want to avail of the Alzheimer Society programs and services
The demographic I work does not see many people living with dementia
Other (please specify)
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3.
Is there anything we can do better to help the referral process?
(Required.)
No
Yes (please specify)
4.
Would you like any of the following:
A poster for your office
Brochures
E-blasts for upcoming events in your community
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5.
Would you like to remain a referring partner?
(Required.)
Yes
No (please specify)
