COVID-19 Information Session Sign Up Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in participating in our 2nd Ward COVID-19 information session about the coronavirus pandemic. The session will be run by two medical students and will start with a prepared presentation about COVID-19, followed by an interactive question and answer session with medical students and a physician. We anticipate the session will last about 1 hour.

Please fill out this form and short survey if you are interested in attending a session. You will receive an email with more information about your session and a link to the Zoom meeting. The email will also contain a link to a feedback form that you can fill out after the session is over so we can continue to make these sessions as useful as possible.

Name *

Email Address *

Which information session would you like to attend? *

Wednesday, May 13th, at 5 pm CST

I am interested but I am not available at the listed time.

I do not want to attend an information session but I would like to receive COVID-19 information sheets by email

Required

We will hold these presentations using the Zoom platform. Do you need more information about Zoom or assistance with using Zoom?

Yes

Clear selection

Overall, how knowledgeable do you feel about COVID-19/coronavirus?

Not very

Very much

Clear selection

How knowledgeable do you feel about the following components of COVID-19?

Not at all

Average

Very

Transmission

Symptoms

Prevention

Treatment

Best Practices

Clear selection

Do you have any questions that you would like us to answer? There will also be time for questions at the end of the presentation.

Anything else you would like us to know?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms