How Can MCMS Best Serve & Support You During COVID-19?

MCMS & MedChi are dedicated to serving you and your practice during the COVID-19 pandemic. Please respond to this brief survey with your preferred contact method(s) and how we may best support you during this time.

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* 1. Please provide us with your best contact information below.

Physician Name:

Practice Name

Primary Specialty:

Preferred Email Address (to receive alerts, notices of next calls, etc.)

Cell Phone Number (to be used only for critical updates)

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* 2. If your practice manager, or other practice staff, would like to receive updates and information from MCMS, please provide their contact information below:

PM/Staff Member Name

Preferred Email Address (to receive alerts, notices of next calls, etc.)

Cell Phone Number (to be used only for critical updates)

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* 3. Is your practice open?

No, our practice is temporarily closed.

No, but we're offering televisits.

Yes, but we're offering appointments only to existing patients.

Yes, and we're accepting new patients.

Not Applicable (I do not work in an office-based setting, etc.)

Other

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* 4. Is your practice providing telehealth services currently?

Yes, and we're currently accepting new patients.

Yes, but we currently are not accepting new patients.

No, but we intend to offer telemedicine services soon. Please follow up.

Maybe, but our practice needs more resources to implement telehealth services. Please contact me.

No, and we do not intend to.

Not Applicable (I do not work in an office-based setting, etc.)

Other (please specify)

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* 5. Would you like your practice included on a referral listing?

Yes, please include my practice on all public and private referral listings.

Yes, but only include my practice on private referral listings

No, do not include my practice on referral listings for now.

Please provide preferred listing contact information:

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* 6. Please note ways in which MCMS & MedChi can support you, your practice, and patients at this critical time.

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* 7. Thank you for taking the time to respond to this survey, and for your commitment to the health and wellbeing of our community. Anything else we should know?