The purpose of this survey is to gain insight into the current situation in pediatric practices in our region as it relates to the COVID-19 pandemic. The results will help us focus on what is most important as we advocate on your behalf. Please complete this by Friday, May 22nd.

Please note: you do not have to answer all questions. Please answer the questions that are most important to you and click the "done" button.

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1. How concerned are you about your practice’s financial health during and after the
COVID-19 pandemic?

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2. How has your volume of patients changed since March 1, 2020?

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3. If your patient volume has decreased, please check the approximate percentage by which patient volume in your practice setting has decreased.

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4. If your practice revenue has decreased during the COVID-19 pandemic, please check the approximate percentage by which revenue has decreased.

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5. What actions has your practice taken as a result of the COVID-19 crisis? (Check all that apply)

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6. If you laid off or furloughed staff, what is the  approximate percentage who were laid off or furloughed?

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7. If you laid off or furloughed physicians, what is the  approximate percentage who were laid off or furloughed?

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8. How many staff or physicians were laid off or furloughed due to COVID-19 concerns related to their age or underlying conditions?

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9. Have you applied for a loan created by the CARES Act from the Small Business
Administration or a private lender?

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10. If you applied for a loan from SBA, please indicate your experience with seeking a loan (Check all that apply):

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11. If you applied for the SBA Paycheck Protection Program, what was your experience?

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12. If you did not apply for a loan created by the CARES Act, please indicate why:

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13. What resources or support would you find most useful? (Please rate your top 5 selections and rank in order of importance using a scale of 1-5, with 1 being the most important. You can drag the options below to prioritize them from 1 to 5)

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14. In what capacity are you currently caring for patients (select all that apply)?

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15. Considering your billable patient encounters in the last month, what percentage of them account for Telemedicine encounters?

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16. I feel that I am adequately prepared to answer parent and/or patients’ questions
about COVID-19

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17. Specific guidelines for diagnosing and treating pediatric COVID-19 cases should be created

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18. The COVID-19 crisis has impacted my ability to provide well visits to my patients

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19. I consider telemedicine to be:

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20. The COVID-19 crisis has impacted my ability to provide vaccines to my patients

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21. What aspects of child and youth health do you think are going to be affected adversely during the COVID-19 pandemic? (check all that apply)

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22. During this COVID-19 outbreak, as a healthcare provider, I am most concerned about:

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23. Please share your personal stories about how the COVID-19 pandemic has impacted your practice and its viability? We are not collecting personal information. All comments shared will be edited to protect the identity of individuals and organizations

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24. Indicate the county where you practice: (Required.)

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25. Please indicate your practice setting (Required.)

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26. How many physicians are in your practice? (Required.)

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27. Please indicate your specialty (Required.)

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28. Approximately what proportion of patients in your practice are covered by the
following insurance types? The sum of all fields should total 100% (Required.)

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29. Please provide your age: (Required.)

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30. Please indicate the gender with which you most identify: (Required.)

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