Tell Us How You Heard about PCIP


Please let us know how you heard about PCIP. We appreciate your feedback!
1. Which one of the following describes your status or interest:
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 a. If you chose TV/Radio, please tell us what station(s):
2 b. If you chose Newspaper/Print Ad, please tell us where you saw the ad:
2 c. If you chose Disease Management Organization, please tell us the name of the organization:
Powered by SurveyMonkey
Check out our sample surveys and create your own now!