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* 1. Indicate your level of satisfaction with the ease at which you were able to access an ActivHealthCare representative able to answer your question.

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* 2. Indicate your level of satisfaction with the professionalism and helpfulness of the ActivHealthCare representative with which you worked.

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* 3. Indicate your overall satisfaction with your experience with ActivHealthCare.

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* 4. Please rate your level of satisfaction with reports and letters you may have received from ActivHealthCare.

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* 5. Please rate if the staff was friendly, courteous and knowledgeable?

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* 6. If follow up or a response was required, was it received within an acceptable time-frame?

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* 7. We would like to hear your feedback in your own words.

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* 8. I am best described as:

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* 9. I am located in:

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* 10. Please provide your contact information.

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