Southwest Region COVID-19 Primary Care Current State and Innovations Survey

General Information

Question Title

* 1. Please provide your contact details.

If you are not comfortable sharing your details, please fill in your role and n/a for rest.

Name

Organization

Role (i.e. physician, NP, etc.)

Email Address

Phone Number

Question Title

* 2. What is your practice type? (i.e. family practice in FHT, community palliative care specialist, etc.)

Question Title

* 3. How has the COVID-19 pandemic affected your patient volumes?

Question Title

* 4. What is the main reason for changes in patient volumes or service delivery?

Question Title

* 5. What, in your opinion, is the single biggest gap/risk or opportunity that needs to be addressed going forward for your practice to succeed through the pandemic?