Thank you for visiting our survey page. To show our appreciation for completing the survey, you will be entered into a drawing for a gift card.

Name of the representative you spoke with:

Based solely on your most recent customer service experience, please rate our Customer Service Representative in the following areas:

5-Excellent
4-Good
3-Average
2-Fair
1-Poor
N/A
Helpfulness 
Professionalism
Issue resolution
Knowledge 

The representative: (please check all that apply)

Answered all my questions
Gave me the wrong information
Couldn't solve the problem
Didn't understand the question
Other:

Overall, how satisfied are you with your recent customer service experience?

Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied

If you are dissatisfied or your issue was not solved, would you like us to contact you?

Yes
No

In the space below, please provide any feedback regarding your experience calling our billing line.


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Patient's Name: 

Hospital:

Phone number in which you called us from: format: ###-###-####


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