Tell Us How You Heard about PCIP

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:
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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 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:
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