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Agents and Brokers Satisfaction Survey

Name
Email
Phone

Overall Satisfaction
1-very satisfied 5-very dissatisfied
Overall, how satisfied are you with the 4MOST Health Network? 1  2  3  4  5
Impression of the Network
1-very satisfied 5-very dissatisfied
How satisfied are you with the geographical access of the 4MOST Health Network? 1  2  3  4  5
What service area(s) would you like to see improved or enhanced? (ie. State, County, City, etc..)
How satisfied are you with the complement of provider specialty types available? (ie. Orthopedic, Dermatology, Surgery, etc..) 1  2  3  4  5
What provider specialty types would you like to see added or enhanced? (ie. Orthopedic, Dermatology, Surgery, etc..)
Your 4MOST Sales & Service Representatives
1-very satisfied 5-very dissatisfied
Overall, how satisfied are you with your sales representative? 1  2  3  4  5
Please rate the following:
My 4MOST Sales & Service Representative,
1-very satisfied 5-very dissatisfied
is sincere & honest in dealing with you 1  2  3  4  5
is considerate of your time 1  2  3  4  5
is knowledgeable of the product features and benefits 1  2  3  4  5
has fulfilled all commitments made to you 1  2  3  4  5
Please rate the following:
My 4MOST Customer Service Representative,
1-very satisfied 5-very dissatisfied
is sincere & honest in dealing with you 1  2  3  4  5
is considerate of your time 1  2  3  4  5
is knowledgeable of the product features and benefits 1  2  3  4  5
has fulfilled all commitments made to you 1  2  3  4  5
Implementation Process
1-very satisfied 5-very dissatisfied
How satisfied are you with the current 4MOST implementation process? 1  2  3  4  5
4MOST Directories are received in a timely manner? 1  2  3  4  5
Marketing
1-very satisfied 5-very dissatisfied
How satisfied are you with the 4MOST quarterly directory updates? 1  2  3  4  5
How satisfied are you with www.4most.com? 1  2  3  4  5
How satisfied are you with the 4MOST PPO Education Brochure? 1  2  3  4  5
What other marketing material(s) do you feel would be helpful?
Do you feel that 4MOST is widely used & recognizable? Yes  No
Additional Comments:
  

 
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