Provider Training Survey - Molina Healthcare of Nevada

1.Title of Training and Date of Training(Required.)

Title of Training:

Date of Training:

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

Low Quality

Average Quality

High Quality

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

Low Quality

Average Quality

High Quality

4.Do you have any recommendations on how we could improve this presentation?(Required.)

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

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

7.Are you interested in joining a regional Provider Advisory Council?(Required.)

Yes

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

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

Comment

Current Progress,

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