* = Required Information

Survey Letter

* All beneficiaries are receiving this survey for quality assurance purposes. In order to better serve you we need your feedback as to where we stand, where we've improved, as well as where you still need to see improvement! We appreciate your candid responses as this will help us to better serve you. Please rank your answer from 1 to 5, with 1 being the worst and 5 being the best.
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
8. Do you see your nurse on a regular basis? At least once per month would be acceptable. Please rate this with 1 being never see nurse to 5 being see nurse once per month.
1 2 3 4 5
Yes No
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