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CIBH Client Survey - Outpatient

2. Enter your unique ID number*
3. Re-enter your unique ID number*
5. I prefer:*

   1. Onsite face-to-face appointments
   2. Telehealth appointments
   3. No preference
6. If you prefer telehealth services, please tell us why (select all that apply)*

   1. Telehealth is more convenient
   2. Transportation concerns
   3. Childcare concerns
   4. Other
8. Other reasons: please explain*
Leave This Blank:


10. 1. Receive an email copy of this form.
11. Email address

    This field is not part of the form submission.

12. Submit

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