Exit this survey Provider Relations Survey Question Title * 1. On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? Very Unlikely Unlikely Likely Very Likely Not Applicable On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? Very Unlikely On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? Unlikely On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? Likely On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? Very Likely On a scale of 1 to 10, how likely are you to recommend MINES as a Provider Network to a peer? Not Applicable Comments Question Title * 2. MINES is considering a new portal that would allow Providers on our panel to pull reports for themselves including authorizations, billings, etc. Would this be of interest to you? Yes No Unsure Other (please specify) Question Title * 3. What, if anything, have you seen from other national panels that you believe MINES should consider doing for our Providers? Question Title * 4. How comfortable are you with using Social Media or Online technology? Confident Comfortable So-So Uncomfortable Not capable Please feel free to add any additional comments Question Title * 5. What is your opinion on using Social Media / Internet clinically? For it On the Fence Against it N/A The Internet generally The Internet generally For it The Internet generally On the Fence The Internet generally Against it The Internet generally N/A Social Media specifically Social Media specifically For it Social Media specifically On the Fence Social Media specifically Against it Social Media specifically N/A Other (please specify) Question Title * 6. What is your current wait time (calendar days) for scheduling a "first appointment" (non-emergency)? 0-2 days 3-6 days 7-10 days 11-14 days 15 or more days Other (please specify) Question Title * 7. Did you join our Panel through the Online Provider Application? Yes No Both Online and Paper Unsure Other (please specify) Question Title * 8. If you joined through our Online Provider Application, did you find it easy to complete? Yes Unsure No Other (please specify) Question Title * 9. Provider Status I am an Affiliate (EAP Provider) I am a PPO Provider I am not currently contracted with MINES I am interested in contracting with MINES Other (please specify) Question Title * 10. Demographics Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Done