NCMS COVID-19 Vaccine Survey Question Title * 1. Have you received a COVID-19 vaccine yet? Yes No OK Question Title * 2. If you have not received the vaccine, do you plan on receiving it? Yes No Already received the vaccine OK Question Title * 3. Do you believe the COVID-19 vaccines that are currently available are safe? Yes No OK Question Title * 4. Will you be recommending the COVID-19 vaccine to patients? Yes No OK Question Title * 5. Do you have necessary information to provide to patients about the science of the vaccine? Yes No Any comments or suggestions: OK Question Title * 6. Do you have the necessary information about where in the vaccination prioritization plan you, your staff and your patients can receive the vaccine? Yes No OK Question Title * 7. Do you have a vaccination policy for your staff? (i.e. are you requiring staff to be vaccinated?) Yes No Not applicable Any additional comments or concerns OK Question Title * 8. What is your current practice model. Independent Affiliated with health system Other (please specify) OK Question Title * 9. What are your biggest challenges in COVID-19 vaccination efforts at this point? Getting access to the vaccine for myself and my staff Coordinating with hospitals and health departments Getting access to the vaccine for patients Keeping up with new science/data/side effects of the vaccines Enrolling as a vaccine provider in CVMS or challenges navigating CVMS system Other (please specify) OK Question Title * 10. Does your practice want to serve as a COVID-19 vaccination location? Yes No OK Question Title * 11. What other information regarding the COVID-19 vaccine would you like us to know? How can NCMS assist you and your practice? OK DONE
