Health Plan Secret Shopper Survey Form
Please complete this survey to evaluate your experience as a mystery shopper for the health plan. All responses are confidential and for assessment purposes only.
Date of your visit or interaction
*
-
Month
-
Day
Year
Date
Type of interaction you evaluated
*
In-person
Phone call
Online/Website
Email
Other
How would you rate the professionalism of the staff or representative?
*
1
2
3
4
5
How clearly was information about the health plan explained to you?
*
Not clear at all
1
2
3
4
Extremely clear
5
1 is Not clear at all, 5 is Extremely clear
Which of the following did you observe during your interaction? (Select all that apply)
*
Friendly greeting
Accurate information provided
Wait time was reasonable
Staff appeared knowledgeable
Other
Was your question or issue resolved during the interaction?
*
Yes
No
Partially
How satisfied are you with the overall experience?
*
Very dissatisfied
1
2
3
4
Very satisfied
5
1 is Very dissatisfied, 5 is Very satisfied
Would you recommend this health plan to others?
*
Yes
No
Not sure
What did you like most about your experience?
Please share any suggestions for improvement or additional comments.
Submit Survey
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