Example CHQ Survey Form eConsult CHQ Survey Demo of CHQ Survey 1. Did receiving this advice from CQH prevent you from referring to a specialist clinic?* Yes No 2. Did receiving this advice Significantly change the care or next steps in care for your patient?*NoSomewhatNot sureYesYes - very much so3. Did this advice line prevent travel for your patient in anyway?* Yes No 4. Did receiving this advice support your learning as a HP in the field?*NoSomewhatNot sureYesYes - very much so5. How important do you think it is that this system is available to HP across the state?*Not sureNot importantSomewhat importantVery importantCriticalGeneral Feedback (Paragraph or Single Line of Text Option)Example of a Checkbox Option First Choice Second Choice Third Choice Example of DropdownCairns and HInterlandCentral QueenslandCentral WestChildren's Health QueenslandDarling DownsGold Coast
