Consumer Engagement

Complete this survey to receive a $10 Meijer gift card and have a chance to win a $75 Meijer gift card! You or your child recently received services from Health Net of West Michigan and we would like to know about your experience.

Question Title

* 1. Are you filling this out for yourself or your child?

Myself

My child

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* 2. How helpful was Health Net staff in connecting you to resources?

Helpful

Neutral

Unhelpful

Does not apply (I was not connected to any resources)

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* 3. After working with Health Net staff, do you feel confident using resources?

Yes

Neutral

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* 4. Did you feel respected by Health Net staff?

Yes

Neutral

Please tell us more:

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* 5. Did you feel that Health Net staff understood your needs?

Yes

Neutral

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* 6. How satisfied are you with your doctor’s office

Satisfied

Neutral

Not satisfied

Please tell us more:

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* 7. Would you recommend Health Net to others?

Yes

Neutral

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* 8. How can Health Net improve?

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* 9. Would you be interested in providing in person feedback at a Health Net focus group?

Yes

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* 10. Please add your name and address below to receive the Meijer gift card.
Disclaimer: Please note that only one $10 Meijer gift card will be mailed to the name and address provided below, and only two $75 Meijer gift card winners will be selected. Health Net cannot provide replacement for lost or stolen gift cards.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

Thank you for completing this survey!