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• Health Insurance Satisfaction Survey Form

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• Your Name (optional)
• Name of Insurance Provider*
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• Overall, how satisfied are you with your insurance provider?

  Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied
• Why did you give the answer above?* Select Cost Customer Service Speed of Payment Type of Coverage Offered Website
• Overall, how satisfied are you with your Insurance plan?*

  Very Satisfied Somewhat Satisfied Neutral Dissatisfied Very Dissatisfied
• Why did you give the answer above?* Select Approval Requirements Approval Speed Coverage Out-of-Pocket Costs Size of Provider Network Variety of Plans Offered
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• How affordable is your health insurance plan?*

  Very Affordable Somewhat Affordable Not Very Affordable Too Expensive
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• What do you like most about your insurance plan?*
• What do you like least about your insurance plan?*
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• Would you recommend this insurance provider to family/friends?*

  Yes No
• What is the main reason for your answer?*
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• May we contact you for further feedback on your opinions?*
  No Yes

  Email or Phone Number
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