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Health and Related Professionals Survey
Health and Related Professionals:
We need the help of additional qualified health professionals and related professionals to supplement our current hospital capacity temporarily as our hospitals are challenged by a surge of seriously ill coronavirus patients. While extensive clinician resources are required to care for critical patients, there is also a need for health care professionals to fill other roles in caring for less acute patients and providing support services.
If you’re available, please complete this survey regarding your experience and your qualifications.
Survey submission may be followed up in the coming weeks with an additional phone survey or direct contact from a healthcare staffing professional.
What is your professional title?
What is your professional title?
Please answer
Physician- Anesthesiologist
Physician- Emergency Department
Physician- Infectious Disease
Physician- Intensive Care
Physician- Pulmonologist
Physician- Surgeon
Physician- Other
Physician Assistant
Specialist Assistant
Registered Professional Nurse
Licensed Practical Nurse
Nurse Practitioner
Clinical Nurse Specialist
Nurse Anesthetist
Respiratory Therapist
Respiratory Therapy Technician
Midwife
Perfusionist
Pharmacist
Physical Therapist
Physical Therapy Assistant
Podiatrist
Dentist
Dental Hygienist
Clinical Laboratory Technologist
Clinical Laboratory Technician
Certified Nurse Aid (Certified by NYS DOH)
Certified Home Health Aide (Certified by NYS DOH)
Mental Health Professionals
Direct Support Professional
Other...
You chose Other, describe experience, specialty, and/or certification
Please list specialties or certifications
Age
Are you a current practitioner
Please answer
Yes
No
Last date of practice
Role in last practice
Are you currently licensed
Please answer
Yes
No
License number
First Name
Last Name
Contact information
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Phone
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NYS county of residence
- Select -
None
Albany
Allegany
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Yates
Would you be willing to work in all regions of New York State?
Please answer
Yes
No
Describe your interest and ability to be able to provide your services to treat patients if the need should arise in the future.
Thank you
With your help, New York State is working to protect our residents and strengthen our public health system. We appreciate your commitment to the health and safety of all New Yorkers and look forward to building on our partnership.
Submit
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