Member Satisfaction Survey

Member Satisfaction Survey - Referral Process Questionnaire

Greater Tri-Cities IPA is interested in receiving our patient's feedback. Listed below are a few simple questions that we would like you to respond to. Please respond to the appropriate questions and use the button at the bottom of the screen to submit your survey. Your response to this questionnaire will assist us in monitoring and improving the care our patient's receive.

*Primary Care Physician:
*Gender: Male Female
*Age:
Member ID#:  (Optional)


1. How long have you been continuously enrolled with Greater Tri-Cities IPA?
2. How many times have you seen your primary care physician in the
    last twelve (12) months?
3. How many times have you been referred by your primary care
    physician to a specialist in the last twelve (12) months?

If you have answered questions 2 and 3 as "None,"
please proceed to the end of the survey and submit your responses.
4. Please rate your experience in obtaining a referral to a specialist within the IPA.
Excellent Good Fair Poor No Experience

5. Once you were referred to a specialist from your primary care physician, how satisfied
    were you with the notification of your referral?
Excellent Good Fair Poor No Experience