ACMAC - COVID impact form
We are trying to gauge how badly everyones community and multibed clinics have been impacted. We know it has been pretty bad for us, but with more data on this we can be more active and targeted in our support.
Please take a couple of minutes to fill this form to help us with this aim.
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Name
Practice name
Practice town
Have you been able to open during the lockdowns?
Clear selection
Have you chosen to open during the lockdowns?
Clear selection
Have patient numbers been impacted by Covid-19?
1 = Decrease a lot, 2 = decrease a bit 3 = stayed the same 4 = increase a bit 5 = increase a lot
Clear selection
Have patients physical and/or mental health been impacted by not being able to access your services?
Clear selection
How badly have patients been impacted?
Not at all
A lot
Clear selection
How has this impacted your income?
1 = Decrease a lot, 2 = decrease a bit 3 = stayed the same 4 = increase a bit 5 = increase a lot
Clear selection
Additional details as to how it has affected you and/or your patients
Any other comments
Submit
Clear form
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