BlueCross BlueShield of Tennessee - Alternative Medicine
Member SATISFACTION SURVEY

Tell Us What You Think
Take this brief survey to provide us with feed back on BluePerks. The survey will only take a few minutes. Your comments will help make the program even better.

Click the appropriate answers for each question (unless otherwise noted).

Please enter your zip code

1. How would you rate your overall satisfaction with Alternative Medicine Discount program and American WholeHealth Network’s services?

5-Very Satisfied
4-Satisfied
3-Neutral
2-Unsatisfied
1-Very Unsatisfied

2.   What practitioner/facility services have you utilized in the past year? (Check all that apply)

Personal Trainer/Exercise Specialist
Acupuncturist
Yoga Instructor
Tai Chi/Qi Gong Instructor
Mind/Body/Relaxation
Nutrition Practitioners
Fitness Centers
Spa
Massage/Bodywork/Somatic Educator
Cosmetic Surgery

3.  Did you see a provider that participates in the BluePerks - Alternative Medicine Discount program network?
Yes
No
If you are seeing a non-AWHN Practitioner please indicate why?

4.   Please rate your satisfaction with the process of finding this practitioner and getting an appointment.

5-Very Satisfied
4-Satisfied
3-Neutral
2-Unsatisfied
1-Very Unsatisfied

5. Please indicate your satisfaction with the available number, choices and locations of the practitioners in this network?

5-Very Satisfied
4-Satisfied
3-Neutral
2-Unsatisfied
1-Very Unsatisfied

6.Would you recommend the practitioners you saw to a friend or co-worker?
Yes
No

7. Do you expect to use the Alternative Medicine Discount program in the next 12 months?
Yes
No

If yes, what practitioners’ services do you expect to use?
Personal Trainer/Exercise Specialist
Acupuncturist
Yoga Instructor
Tai Chi/Qi Gong Instructor
Mind/Body/Relaxation
Nutrition Practitioners
Fitness Centers/Spa
Massage/Bodywork/Somatic Educator
Cosmetic Surgery

8. As a result of your care, how have the frequencies of the following changed:
(1)Decreased--Neutral-->Increased(5)
· Visits to your primary care physician 1  2  3  4  5
· ER/urgent care visits 1  2  3  4  5
· Specialist visits 1  2  3  4  5


9. As a result of using the program how were the following affected?
(1)Decreased--Neutral-->Increased(5)
· Need for surgery 1  2  3  4  5
· Sick days 1  2  3  4  5
· Pain 1  2  3  4  5
· Enjoyment of life 1  2  3  4  5
· Activity level 1  2  3  4  5
· Use of prescription drugs 1  2  3  4  5
· Use of over-the-counter drugs 1  2  3  4  5


10. Have you purchased Nutritional Supplements through the BluePerks program?
Yes
No
Comments:

11. Have you reviewed the Health and Wellness information that is available on line through BluePerks?
Yes
No
If YES, what is your favorite section (check all that apply)
Healing Centers
Healing Kitchen
Expert Opinions
Reference Library
News & Perspective
Comments:

12. What services would you like to see added to the BluePerks program?
(check all that apply) Cosmetic Dentistry Discounts Weight Loss Programs Discounts on Hearing Aids Smoking Cessation programs Other:

Thank you for completing this survey. This section is optional and will be kept confidential. Please use the box below to add additional comments.


1. What is your gender?
Female
Male

2. What is your marital status?
Married
Living as married
Single
Divorced or Separated
Widowed

3. Into which of the following categories does your age fall?
Under 25
25 to 34
35 to 44
45 to 54
55 to 64
65 or over

4. What was the last year of education you completed?
Some high school
High school graduate
Trade / technical school
Some college
College graduate
Masters / doctors degree/ Post graduate work
Other

5. What is your total annual household income before taxes?
$10,000 or less
$10,001 to $25,000
$25,001 to $35,000
$35,001 to $45,000
$45,001 to $55,000
$55,001 to $75,000
$75,001 to $100,000
Over $100,000

Would you like someone from American WholeHealth Networks to contact you? If so please provide your name, address, and phone number below: