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* 1. In which state are you located?

Please slide the dot from left to right to indicate your level of agreement with each statement.

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* 2. I was very satisfied with the information/help I received when I contacted you for assistance.

Strongly disagree Neither agree nor disagree Strongly agree
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i We adjusted the number you entered based on the slider’s scale.

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* 3. The quality of the information your organization provided was excellent.

Strongly disagree Neither agree nor disagree Strongly agree
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i We adjusted the number you entered based on the slider’s scale.

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* 4. I would recommend your organization to other clinicians who need help preparing for MIPS/QPP/MACRA.

Strongly disagree Neither agree nor disagree Strongly agree
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i We adjusted the number you entered based on the slider’s scale.

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* 5. The level of TA we provided was given at your level of need and provided great value to your office/operations.

Strongly disagree Neither agree nor disagree Strongly agree
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i We adjusted the number you entered based on the slider’s scale.

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* 6. If you are especially satisfied or dissatisfied, we'd like to hear more! Please provide information here. If you'd like to discuss it further, please send your contact information to us at QPPSURS@AlliantQuality.org.

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* 7. Please check all of the ways in which we provided technical assistance:

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* 8. Optional - Please share any suggestions to help us improve our customer assistance.

Would you like more information? Please email us at QPPSURS@AlliantQuality.org or call us at 1-844-QPP-TOOLS (844-777-8665).

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