CCHN Website Feedback Survey Question Title * 1. Please indicate your practice-type Primary Care Specialist Ancillary Hospital Health Department Question Title * 2. Are you a member, provider or visitor? Member Provider Visitor Question Title * 3. What was your primary reason for visiting the CCHN website today? Get health plan info or request a contract to join the network Access a policy, form, manual, training/education or other resource Check or submit a prior authorization Access the secure provider or member portal View or submit claims Verify eligibility Contact us Other (please specify) Question Title * 4. Were you able to complete your task and/or find the information you needed? Yes No Other (please specify) Question Title * 5. Overall, on a scale of 1 to 5 with 5 being the most satisfied, how satisfied were you with your experience using our website today? 1 - Very dissatisfied 2 - Dissatisfied 3 - Neutral - neither satisfied nor dissatisfied 4 - Satisfied 5 - Very satisfied Question Title * 6. If you would like someone from the health plan to reach out to you or if you would like to offer additional feedback, please complete the form below. Name/Title Practice/Organization Email Address Phone Number Done
