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COVID Connect survey
Thank you for volunteering your time to support health professionals in India during CV-19. Please complete this short survey which will help us coordinate your interest with the need in India.
Thank you, the COVID Connect Team
1.
Name
2.
Contact (phone/mobile/email)
3.
Indian Languages spoken
Hindi
Bengali
Marathi
Telugu
Tamil
Gujarati
Urdu
Kannada
Odia
Malayalam
Punjabi
Sanskrit
English
Other (please specify)
4.
Medical Specialty and APHRA registration number (if registered)?
5.
Will you be interested in providing telehealth for home based care?
Yes
No
6.
Will you be interested in providing peer support to young health professionals?
Yes
No
7.
Will you be interested in doing well-being checks/ mentoring young health professionals?
Yes
No
8.
Where in Australia are you based?
NSW
VIC
QLD
ACT
SA
WA
NT
TAS