Phone surveys management form

Phone surveys management form

If you have phone surveys to manage, this form allows you to record all the collected information. Form Preview
  • Holland Lead Screening Form

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  • Holland Lead Types & Verbiage

  • Lead Source:

    Medicare Changes = "New Medicare Changes & Benefits"

    Age-In = "Facts about your Federal Benefits 2014 for those turning 65"

    LIS or Extra Help = "Getting Extra Help paying for your prescription drug benefits under Medicare"

    VA or VA Card = "Additional healthcare benefits for Veterans"

    Diabetes = "Medicare Programs for those with Diabetes"

    Free Rx Card = "Getting a Free Prescription Drug Discount Card to work with your Medicare benefits"

    Obamacare = "How your Medicare benefits will impacted by Obamacare"

  • Introduction

  • Hello, may I speak to Mr./Ms.____________, my name is Naamah, and I am an assistant at the Senior Processing Center. I’m calling because you had requested some information on:  <> (see Lead Source Table)

    Your case was assigned to Khari Garrett, the benefits specialist who I am assistant to, but I am calling to gather some basic information and to schedule a time when the two of you can speak. Your case has been open since <> so we are eager to make some progress and cover what needs to be covered.

    I’m going to need to ask you some very quick questions and then I’m going to pass that information on to Khari along with the time that you wish to be contacted and he will go over the specific information with you. Okay?

  • Current Coverage

  • Doctor Information

  • Other information provided by beneficiary...

  • Appointment Preferrences

  •  -  -
    at
     :
    Pick a Date
  • Wrap-up

  • Okay Mr./Ms. _______________, I'm passing this information along to Khari. He's the absolute best! If he happens to not call at the specific time you requested, it's because he has to give each Medicare Beneficiary individual attention and may be on an appointment that runs a bit longer than expected, but he will call you as close to the time-frame you specified. Think of any questions you may have for him between now and then. Okay?

    If you need to change your appointment window, please call me. My name is Naamah and my number is (800) 856-5998. In addition, you may call Khari. He is the specialist that will be working with you and his direct number is  (800) 481-4784. He is wonderful and works with quite a number of beneficiaries, so I'm sure he'll treat you well just the same.

  • Submit

  • Should be Empty: