4MOST HEALTH NETWORK

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Provider Satisfaction Survey

To help us serve you better, we would like for you to complete the following provider satisfaction survey. Your input is important to us and we greatly appreciate you and/or your staff taking a few minutes to complete this survey which in turn will help us to better serve you. Additional comments and suggestions are welcome. If you have any questions, please contact our Network Affairs Department at 888-258-6477.

Overall Satisfaction

1-very satisfied 5-very dissatisfied

Overall, how satisfied are you with the 4MOST Health Network?

Customer Service

1-very satisfied 5-very dissatisfied

Were they friendly and helpful?

1 2 3 4 5

Were your questions answered?

1 2 3 4 5

Were you able to resolve your questions and/or problem?

1 2 3 4 5

Willingness to assist you with your questions?	1 2 3 4 5
Overall how satisfied were you with our customer service department?	1 2 3 4 5

Crendentialing

1-very satisfied 5-very dissatisfied

Were they friendly and helpful?

Were your questions answered?

1 2 3 4 5

Were you able to resolve your questions and/or problems?

1 2 3 4 5

Willingness to assist you with your questions?

1 2 3 4 5

Overall how satisfied are you with our credentialing department?

1 2 3 4 5

Networking Affairs / Provider Relations

1-very satisfied 5-very dissatisfied

Were they friendly and helpful?

1 2 3 4 5

Were your questions answered?	1 2 3 4 5
Were you able to resolve your questions and/or problems?	1 2 3 4 5

Willingness to assist you with your questions?	1 2 3 4 5
Overall how satisfied are you with our provider relations?	1 2 3 4 5
How satisified are you with the following	1-very satisfied 5-very dissatisfied
Your 4MOST reimbursement?	1 2 3 4 5
Your reimbursement compared to our competitors?	1 2 3 4 5
Our credentialing and recredentialing processes?	1 2 3 4 5

Provider Name, Address and Phone number: (Optional)

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