Thank you for taking a few moments to help your TMA gather more data on its members and the impact that this pandemic is having on you, your practice and your patients. We will use this information to help us gauge issues facing our members to develop future programs and services to  help you.

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* 1. How many FTE providers in your practice?

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* 2. Describe your practice location

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* 3. If both, what percentage of providers practice in rural areas?

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* 4. Estimate the percentage decrease in office visits in your practice since the onset of the COVID-19 pandemic?

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* 5. Estimate the percentage decrease in medical procedures you perform per week due to the COVID-19 pandemic?

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* 6. How has your practice revenue been impacted since the beginning of pandemic?

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* 7. Have you or do you plan to close your practice?

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* 8. Has your practice received financial assistance from government-funded assistance programs?  

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* 9. What percentage of patient visits have you conducted via telemedicine…

  Before COVID-19 pandemic During COVID-19 pandemic
0%
1-10%
11-25%
26-50%
51-75%
76-99%
100%

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* 10. Overall what has been the perception of the use of telemedicine in your practice?

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* 11. At your practice, who uses PPE during operating hours?

  Yes No Varies
Clinical staff
Clerical staff
Patients

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* 12. Estimate the quantities of PPE you currently have available at your practice for staff and patients.

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* 13. Do you have a consistent supply chain for getting PPE if you were to open on May 1?

  Yes No
PPE
Masks
Gloves
Gowns/covers
Swabs
Disinfecting supplies

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* 14. What staffing modifications have you made due to Covid-related financial challenges?

  0% Reduction 1-10% Reduction 11-25% Reduction 26-50% Reduction 51-75% Reduction 76-100% Reduction
Clerical Staff
Nursing Staff
NP/PA Staff
Physicians

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* 15. Overall, how concerned are you about the negative long-term effects of the COVID-19 pandemic on your practice?

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* 16. What are your primary concerns/thoughts about the effects of the COVID-19 pandemic on your practice?

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* 17. Is your practice primary care?

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* 18. Practice ownership - my practice is ....

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* 19. Name

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* 20. Practice name

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* 21. Please provide your e-mail address

0 of 21 answered
 

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