We appreciate the opportunity to support you in the care of your patients who are covered under Parkland Community Health Plan and enrolled in the "Be In Control" program. Your feedback is very important to us.

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* 1. Physician Name (*Required)

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* 2. My patients are generally satisfied with the LM/DM program.

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* 3. I am satisfied with how the LM/DM program has assisted my patients in complying with their treatment plan.

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* 4. I am satisfied with the quality of LM/DM program communications I have received from your program.

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* 5. I am satisfied that your LM/DM program is based on evidence-based guidelines and standards of care.

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* 6. I am satisfied with the helpfulness of staff who service your LM/DM program.

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* 7. With respect to the LM/DM program overall, I am satisfied.

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* 8. Survey completed by (optional):

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* 9. What would you like to see improved in the program?

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* 10. If you wish to be contacted regarding your survey responses/comments, please enter your phone number and/or email address below.

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