2015 Alaska Primary Care Needs Assessment

Introduction

Thank you taking the time to participate in this important project. Your answers will help create a deeper understanding of primary care practice in Alaska and help identify the specific needs and issues affecting providers, individuals, families and communities across the state. We are excited you are part of this project and look forward to working together.

If you have any questions or concerns about this survey, please contact Susan Mason-Bouterse at susan.mason-bouterse@alaska.gov or Christiann Stapf at christiann.stapf@alaska.gov.

Question Title

* 1. Please tell us about your organization.

Contact Name and Title *

Organization Name *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country:

Email Address: *

Phone Number: *

Question Title

* 2. What types of services does your agency/organization offer? (Please select all that apply.)

Primary Care - Physical Health

Behavioral Health

Dental