COVID-19 survey

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COVID-19 survey

We are a medical education provider for healthcare professionals and patients, looking to create an educational program about COVID-19 for healthcare providers such as doctors and nurses. These educational programs are important to educate providers with the necessary knowledge and skills to identify, diagnose and treat people with COVID-19.

We would like to ask some questions about you and your experience of COVID-19 care. This information will help us plan this upcoming free educational program for healthcare providers.

The information you provide will be kept entirely confidential and will never be traced back to you as an individual. This information will be used for statistical and research purposes only and will be stored securely. If there are any questions you do not wish to answer, move on to the next question. If answering as a caregiver or relative, please answer regarding the person you care for.

We would appreciate it if you could provide us with this demographic information about yourself. This is so we can better ensure we are reaching people from all age groups, genders and countries. You can answer all, some, or none of these questions. If you prefer not to answer, please move on to the next question.

Thank you so much for your help!

1. Please indicate your age range:

Under 18

18–24

25–34

35–44

45–54

55–64

65+

Prefer not to answer

Clear selection

2. The gender you identify with:

Woman

Man

Nonbinary

Other/Prefer to self-identify

Prefer not to answer

Clear selection

3. Have you had COVID? (Select one)

Yes, I tested positive or I was told by a healthcare professional I had COVID

I think so, but I tested negative

I think so, but I didn’t get tested

Not sure / Don’t know

No - I had a negative test result or don’t think I had COVID

4. Which of the following healthcare providers (if any) have you seen about COVID? (Select all that apply)

Primary care physician / General practitioner / Family doctor

Pulmonologist (lung specialist)

Allergologist/Immunologist (immune system specialist)

Emergency room doctor / Accident & emergency doctor

Pediatrician (children/young people specialist)

Intensive care doctor

Occupational (workplace) physician

Other type of doctor

Nurse or nurse practitioner

Pharmacist

Physiotherapist

Occupational therapist

Complementary and alternative medicine provider, such as an acupuncturist or homeopath

Another healthcare provider

None of the above

5. How satisfied were you with the overall amount and quality of information about COVID-19 given to you by your treating healthcare provider? (Select one)

Very satisfied

Satisfied

Neutral / Don’t know

Dissatisfied

Very dissatisfied

Not applicable - I haven’t had COVID-19 or didn’t want/need information

Clear selection

6. Has a healthcare provider ever discussed with you about risk factors that could put you at risk of having a more severe COVID-19 infection? Risk factors may include being older, unvaccinated, or receiving treatment with immunosuppressants (medications that “damp down” your immune system). (Select one)

Yes

Not applicable - I haven’t had COVID-19 or didn’t want/need information

Clear selection

7. How often did your treating healthcare provider involve you in making shared decisions about COVID-19 diagnosis and treatment? (Select one)

Always

Often

Sometimes

Rarely

Never

Not applicable - I haven’t had COVID

Clear selection

Submit

Clear form

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