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Aetna Better Health of Florida OB/GYN Survey
Survey
Aetna Better Health would like to obtain more information regarding our obstetrician (OB) physician network to improve services for mothers and infants.
Please take a moment to respond to this 2 minute survey.
*
1.
Group Information (all fields are required)
(Required.)
Group Practice Name
Group TIN
Group NPI
*
2.
Practitioner Information (all fields are required)
(Required.)
Practitioner Name
(Last, First)
Practitioner Title
Practitioner NPI
*
3.
Submitter Information
(Required.)
First and Last Name
Title
Phone
Email
4.
Does your practice provide Telemedicine/Telehealth services?
Yes
No
*
5.
Is the Practitioner a buprenorphine waivered practitioner from SAMHSA?
(Required.)
Yes
No
*
6.
Is the Practitioner a Black or African American woman?
(Required.)
Yes
No
*
7.
Is the Practitioner a Hispanic or Latino woman?
(Required.)
Yes
No
*
8.
Does the Practitioner fluently speak English and Spanish?
(Required.)
Yes
No
