In order to continuously improve the quality of Arise Health Plan’s Health Management Program, we would welcome your feedback. Please take a few minutes to complete this survey. Your responses
will be completely anonymous unless you choose to include your name.
Case Manager:  Hossam "Sam" Shalaby

* 1. Your Name (optional):

* 3. I am the:

* 4. How many times did you speak to your Case Manager?

Please select your Satisfaction Level for questions 5 - 11.

* 5. I was able to contact my Case Manager whenever I needed assistance.

* 6. I worked with the Case Manager to determine the schedule and frequency of our contacts.

* 7. The Case Manager helped me understand my medical condition and treatment plan.

* 8. The educational materials received were helpful.

* 9. The Case Manager helped me follow my treatment plan and reach my goals.

* 10. The Case Manager assisted me in obtaining the health care or services I needed.

* 11. The Case Manager helped me understand my Arise Health Plan healthcare benefits.

* 12. I was satisfied with the Health Management program.

* 13. Would you recommend Arise Health Plan’s Health Management program?

* 14. How could Arise Health Plan make the Health Management process more valuable to you or your family/caregiver?

Thank you for participating in the survey!