Provider Training Survey

Your feedback is important, and You Matter to Molina. You are a valued provider partner. Please complete this survey to ensure we make the Molina Provider Training Sessions as valuable to you as possible. This survey will take approximately 5 minutes to complete. Thank you!

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* 1. Title of Training and Date of Training

Title of Training:

Date of Training:

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* 2. What did you think of the quality of the material presented today? Please choose an option below:

Low Quality

Average Quality

High Quality

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 3. What did you think of the quality and clarity of today’s presenter? Please choose an option below:

Low Quality

Average Quality

High Quality

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 4. Do you have any recommendations on how we could improve this presentation?

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* 5. Do you have any recommendations on how we could improve our relationship with your office?

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* 6. What training topics would you like to see offered by Molina in the future?

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* 7. Are you interested in joining a regional Provider Advisory Council?

Yes

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* 8. If you answered "Yes" to joining a regional Provider Advisory Council, please provide your contact information below:

Group Name

Your Name

TIN

Email Address

Phone Number

Fax Number

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* 9. If you would like Molina to follow up with you on the feedback provided on this survey, please provide the contact information below:

Group Name

Your Name

TIN

Email Address

Phone Number

Fax Number

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