* 1. Indicate your level of satisfaction with the ease at which you were able to access an ActivHealthCare representative able to answer your question.

* 2. Indicate your level of satisfaction with the professionalism and helpfulness of the ActivHealthCare representative with which you worked.

* 3. Indicate your overall satisfaction with your experience with ActivHealthCare.

* 4. Please rate your level of satisfaction with reports and letters you may have received from ActivHealthCare.

* 5. Please rate if the staff was friendly, courteous and knowledgeable?

* 6. If follow up or a response was required, was it received within an acceptable time-frame?

* 7. We would like to hear your feedback in your own words.

* 8. I am best described as:

* 9. I am located in:

* 10. Optional: Please provide your contact information if you would like a response.

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