Medical Home Portal Survey

Question Title

* 1. Did you find what you were looking for?

	Yes	No	N/A
A needed service	A needed service Yes	A needed service No	A needed service N/A
A needed specialist	A needed specialist Yes	A needed specialist No	A needed specialist N/A
A needed support	A needed support Yes	A needed support No	A needed support N/A
Helpful information	Helpful information Yes	Helpful information No	Helpful information N/A

Question Title

* 2. What is the likelihood that you'll visit the Medical Home Portal in the future?

Definitely

Very likely

Somewhat likely

Not likely

N/A

Definitely

Very likely

Somewhat likely

Not likely

N/A

Comments (optional)

Question Title

* (Optional) If you’re willing to provide additional feedback about our site, please leave the information requested below and we will contact you sometime in the next month or two. We will never sell or share your information or spam you, and you can opt out at any time. Thank you!

Name

State/Province

Email Address

Question Title

* Your Role (optional)

You won’t see the survey banner again but can take it again anytime by clicking the 'Take Survey' link in the upper right of any Portal page (other than the home page).