Molina Operations Meeting Survey

Your feedback is important, and It Matters to Molina. As a valued partner, please complete and submit the survey below. This survey will take approximately 3-5 minutes to complete. Thank you!

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* 1. Name of Hospital:

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* 2. Please rate your satisfaction level on each item below:

  Dissatisfied Somewhat Dissatisfied Neutral Somewhat Satisfied Satisfied
How would you rate the meeting?
Did the Molina Representative(s) meet your expectations?
Knowledge of the Molina Representative(s) on the subject matter?
Did the subject matter meet your needs?
Were all of your concerns addressed?

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* 3. Attendance at this meeting was well worth the time invested?

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* 4. If you answered "No" to attendance being well worth the time invested, please provide additional comments:

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* 5. Do you have suggestions for future meetings?

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* 6. Do you believe your Molina Provider Services Representative is giving you quality service?
   (Acceptable response times, resolution/escalation of issues, etc.)

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* 7. Is there anyone at Molina that you would like to recognize or bring to management's attention?

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* 8. Please share any comments, concerns, ideas or feedback (positive or negative):

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* 9. Are you interested in joining a regional Provider Advisory Council?

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* 10. If you answered "Yes" to joining a regional Provider Advisory Council, please provide your contact information below:

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* 11. If you would like Molina to follow up with you on the feedback provided, please provide the contact information below:

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