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* 1. Are you willing to work some shifts in a COVID-19 Assessment Centre that may need to be activated in the coming weeks? These are proposed to be 6 hour daytime shifts and you would be compensated an hourly or sessional fee.

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* 2. Would you be willing to work in hospital or LTC facility or other settings other than your office or the COVID-19 assessment clinic mentioned above if physicians were needed to cover care in those settings.

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* 3. Are you able to provide virtual visits (telemedicine) currently for your patients?

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* 4. Would you be willing to provide virtual visits to other patients who are not your own patients if this becomes a billable service?

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* 5. If you are not currently able to provide virtual visits, would you like help to set this up to be able to offer this?

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* 6. Name

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* 7. Best Contact Number

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