Acupuncture For The People Clinic Re-Opening Survey June

1.What is your age?

2.Are you at high-risk for severe illness or complications from COVID-19?
(For Example: immune compromised, chronic lung disease, moderate to severe asthma, serious heart conditions, diabetes, immune deficiencies, HIV/AIDS, other autoimmune conditions, chronic kidney or liver disease, undergoing dialysis, cancer treatment or organ transplant)

Yes

No

I'm not sure

3.Describe your lifestyle in response to the Pandemic:

Still at workplace interacting with the public (essential workers)

Still at workplace interacting with other workers

Working from home, limited contact with others

Not working, Staying at home, only leaving for needed errands

Full quarantine, not leaving home, no contact with others, deliveries only for supplies

Life as usual - Not following quarantine guidelines (no social distancing, masks)

Other (please specify)

4.What is your level of need for Acupuncture Services?

Very High: I can’t function at all without regular Acupuncture

High: I need Acupuncture right now, I’m struggling without it

Moderate: I could really use a treatment, but I’ll survive without it

Low: A relaxing treatment would be nice, but I’ve got other priorities

None: I don’t feel that I need / want Acupuncture at this time

5.It's hard to predict, but when do you think you would you feel comfortable / safe returning to our clinic for treatment?

6.What influences your decision of when to return for Acupuncture? (see previous question)

Money concerns /reduced income

Concern about contracting Covid-19

Concern about spreading Covid-19 to others / loved ones

The current # of new Covid-19 cases in the news

Testing access & availability, Contact tracing, etc.

Other (please specify)

7.We will be taking extra precautions to protect staff & clients. Part of that approach involves everyone wearing a mask inside the clinic. What describes your attitude towards masks?

I can provide my own mask while in the clinic.

I will need a mask provided for me to wear.

I cannot wear a mask due to a health / comfort issue.

I refuse to wear a mask for any reason.

Other (please specify)

8.When the clinic first re-opens it will be for reduced hours. When would be your preferred time to come in for Acupuncture treatment? Check all that apply.

9.We may have to raise our rates (sliding-scale) to cover added expenses and reduced volume. Our goal is to keep treatments affordable and accessible. Based on your current situation, what could you reasonably afford to contribute?

Acupuncture For The People Clinic Re-Opening Survey June

Your input & feedback is important to us now more than ever.