Website Survey for Providers

Take this brief survey and be entered for a chance to win a free iPod!

Your survey responses will not be matched with your contact information in any way.

Survey Deadline: Friday, November 14


A red asterisk (*) indicates required questions.

Is this your first visit to L.A. Care’s Website?
Yes
No


How often do you visit L.A. Care’s Website?
This is my first visit
1-3 times a month
4-6 times a month
More than 6 times a month


Why do you visit L.A. Care’s Website? Select up to 3 choices.
News Updates
Register for Events
Download Forms
Access L.A. Care Connect
Check Patient Eligibility
Check on Claims
Search Formulary
Mental Health Resources
Health Education for Patients
Other
This is my first visit


What is the best feature of L.A. Care's new Website?
Downloadable Forms Page
Searchable Formulary
Online Event Registration
RSS News Feed
Search Box
Printer-Friendly Format


Now that you've seen L.A. Care's new Website, how likely are you to return?
Highly Likely
Somewhat Likely
Not at all Likely


Fill out the form below to enter for a chance to win a free iPod! Your survey responses will not be matched with your contact information in any way.

Name:*


Job Title:*


Organization Name:*


E-mail Address: *


Phone Number:


Organization Address (include address, city, state & zip code):*


Select YES if you would like to receive occasional news updates from L.A. Care via e-mail.*
Yes
No