Tell Us How You Heard about PCIP
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Instructions
Please let us know how you heard about PCIP. We appreciate your feedback!
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1. Which one of the following describes your status or interest:
I am applying for PCIP
I am already enrolled in PCIP
I am not applying or enrolled in PCIP at this time, I am just interested in learning about PCIP
1. Which one of the following describes your status or interest:
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2. How did you hear about the PCIP Program? Please select all responses that apply.
(Please note that questions 2a, 2b and 2c may not be applicable to your selections)
2. How did you hear about the PCIP Program? Please select all responses that apply. (Please note that questions 2a, 2b and 2c may not be applicable to your selections)
Insurance Agent/Broker
Health Fair/Community Event
Billboard
Community Clinic
Pharmacy
Health Insurance denial letter
Employer
Church
Certified Application Assistant
Website/Internet
Doctor's office
Hospital
Government Office
Friend/Relative
TV/Radio (see question 2a)
Newspaper/Print Ad (see question 2b)
Disease Management Organization (see question 2c)
Other
2 a. If you chose TV/Radio, please tell us what station(s):
2 a. If you chose TV/Radio, please tell us what station(s):
Walgreens
KOST: FM-103.5
KFI: AM-640
KBIG: FM-104.3
Radio Streaming (online)
The Wave: 94.7
KRTY: FM-95.3
KEZR: FM-160.5
KBAY: FM-94.5
KMJ: AM-580
KFRG: FM-95.1, 92.9
KMGV: FM-97.9
KOLA: FM-99.9
KSKS: FM-93.7
KLIV: AM-1590
Other (please specify)
2 b. If you chose Newspaper/Print Ad, please tell us where you saw the ad:
2 b. If you chose Newspaper/Print Ad, please tell us where you saw the ad:
Los Angeles Times
San Francisco Chronicle
San Jose Mercury News
Sacramento Bee
Fresno Bee
Other (please specify)
2 c. If you chose Disease Management Organization, please tell us the name of the organization:
2 c. If you chose Disease Management Organization, please tell us the name of the organization:
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