MSNVA Community Physicians Preparedness Survey Question Title * 1. Please provide the name of your practice, specialty, and address. Question Title * 2. Please provide full name, title, phone number, and email for point of contact person(s). Question Title * 3. In the past month, have you ordered any PPE supplies? No If yes, how long did it take to receive your order? Question Title * 4. How many staff members do you have in your office, including yourself? Question Title * 5. Do you have PPE supplies in your office? No Yes Question Title * 6. Are you using PPE for everyone in your office, how are you managing allocation? No Yes Please Explain Question Title * 7. How many of the following supplies, do you think, you need for your office? N95 masks Surgical masks Goggles Face shields Gowns Gloves Question Title * 8. If you are a retired physician, are you able to volunteer in a clinical capacity? No If yes, please provide a phone number and/or email. Question Title * 9. Do you have any PPE supplies you can donate or sell to front line physicians? No If yes, please provide contact infomation. Question Title * 10. If you had adequate supplies of PPEs, are you willing to offer COVID-19 testing in your office? No Yes Please provide recommendations Done