Provider survey We're always working to improve service to our providers! Help us by filling out this brief survey. Question Title * 1. Please indicate your area of medicine. (Mark all that apply) Primary Care Specialty Behavioral Health Clinician Other (please specify) Question Title * 2. Please mark who is completing this survey. (Mark only one) Physician Behavioral Health Clinician Office Manager Nurse Other Staff (please specify title): Question Title * 3. If you have an NPI, please share: Question Title * 4. What is the name of your medical group: Question Title * 5. What is your preferred method of receiving communications from this health plan? Mail Telephone Fax E-mail Please indicate your e-mail address: Question Title * 6. Do you have a Provider Relations representative from this health plan assigned to your practice? Yes No Next
