Consumer 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. Orthopaedic, Dermatology, Surgery, etc..)

1  2  3  4  5

What provider specialty types would you like to see added or enhanced? (ie. Orthopaedic, Dermatology, Surgery, etc..)

Your 4MOST Service Representatives

1-very satisfied 5-very dissatisfied

Overall, how satisfied are you with 4MOST Customer Service?

1  2  3  4  5

Please rate the following: My 4MOST Customer Service Representative,

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

Marketing

1-very satisfied 5-very dissatisfied

How satisfied are you with www.4most.com?	1  2  3  4  5
Do you feel that 4MOST is widely used & recognizable?	Yes  No

Additional Comments: