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Qlarant Florida Provider Feedback Survey
Provider Review Information
We are seeking your feedback on the Provider Discovery Review (PDR) Qlarant recently completed with your organization. Your input is very important to us. Thank you for participating.
*
1.
Type of Provider (choose one)
(Required.)
Solo
Agency
*
2.
APD Region
(Required.)
Northeast
Northwest
Central
Suncoast
Southeast
Southern
*
3.
Month of Review
(Required.)
January
February
March
April
May
June
July
August
September
October
November
December
*
4.
Year of Review (YYYY)
(Required.)
5.
Provider's Name (Optional)
6.
Reviewer's Name (Optional)
