COVID-19 Clinic Survey
Please answer the following questions so that we can stay up-to-date on how COVID-19 is affecting your clinic staff and volunteers.
Sign in to Google to save your progress. Learn more
Have you had any staff or volunteers test positive for COVID-19? *
If yes, how many?
If yes, what changes have you made to your clinic practices?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Charitable Healthcare Network. Report Abuse