Healthcare Provider Contacts Survey

Healthcare Provider Contact Information

Dutchess County Department of Behavioral & Community Health regularly contacts healthcare providers by email, fax, or telephone to provide health alerts, advisories, and updates regarding emerging infectious diseases, outbreaks, and other areas of concern.

Please complete this brief survey to update your contact information for this purpose. If you have any questions, please contact Patricia Munk, Public Health Education Coordinator, at (845) 486-3559 or pmunk@DutchessNY.gov.

Thank you for taking time to assist us.

1.Name of Group or Practice(Required.)

2.Specialty of Practice(Required.)

3.Second Specialty (if applicable)

4.Group/Practice Information(Required.)

Mailing Address

City/Town

State/Province

ZIP/Postal Code

Phone Number

5.Physical Location, if different from above

Address

City/Town

County

6.Email of the person(s) responsible for distributing information (health alerts, advisories, & updates) to providers

Email Address1

Email Address2

Email Address3

7.Fax number

8.Does your practice have an urgent care center?(Required.)

Yes. Please provide Primary Contact's phone number and email:

9.Are you satisfied with how you receive information from the Dutchess County Department of Behavioral & Community Health?(Required.)

Yes

Please feel free to share with us any recommendations you may have on how we can improve our distribution of information to you:

10.Additional comments: