1-888-719-9990 | info@chirohealthusa.com

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About
Providers
Members
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Students
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ChiroAI™

Provider Onboarding Survey

Thank you for becoming a provider with ChiroHealthUSA. We like to follow up with our new clinics to find out how we can improve our onboarding process. Your honest responses help us improve the process.

Please take a moment to complete this short survey on your ChiroHealthUSA onboarding experience.

(Drawings will be held on the last day of each calendar quarter.)

5 Quick Questions…

Win a $150 Amazon gift card!

Contact Information

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How would you like to take the survey?(Required)

Provide Contact Info and Enter Drawing

Anonymously (not entered for drawing)

Your submission will be anonymous, but you will not be entered into the drawing.

This information is required to be entered into the drawing.

Provider Name(Required)

First Last

Clinic Name(Required)

ChiroHealthUSA may share my remarks to promote the program to other providers.

Give permission to share?(Required)

YES

1. What convinced you to become a provider with ChiroHealthUSA? (Mark all that apply.)

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Webinar

I watched a webinar about ChiroHealthUSA.

Consultant

A consultant suggested ChiroHealthUSA.

Which Consultant?

Speaker

I heard a speaker talking about ChiroHealthUSA.

Which Speaker?

Colleague

A colleague recommended ChiroHealthUSA.

Which Colleague?

I saw an advertisement about ChiroHealthUSA.

Which Publication was the ad in?

Article

I read an article about discounting and financial policies.

Which Publication was the article in?

2. How would you rate the following aspects of your onboarding experience?

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Working with a consultant on my fees and financial policy.(Required)

Very helpful

Somewhat helpful

Not helpful

N/A

Working with my CHUSA network specialist on the enrollment process.(Required)

Very helpful

Somewhat helpful

Not helpful

N/A

Learning how to discuss ChiroHealthUSA with my patients.(Required)

Very helpful

Somewhat helpful

Not helpful

N/A

Discovering how easy it is to incorporate ChiroHealthUSA into my practice.(Required)

Very helpful

Somewhat helpful

Not helpful

N/A

3. What was the most challenging area of your onboarding experience?

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Most challenging area(Required)

Deciding what my discounted fees will be.

Getting my staff trained on ChiroHealthUSA.

The length of time it takes to become a provider.

The amount of paperwork required.

Other (please explain)

Please explain the most challenging area of your onboarding experience.(Required)

4. How likely are you to recommend ChiroHealthUSA to your colleagues?

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Recommend ChiroHealthUSA(Required)

Very likely.

Somewhat likely.

Somewhat unlikely.

Very unlikely.

5. BONUS ENTRY: Please share your thoughts on why you became a ChiroHealthUSA provider and how it is helping your clinic.

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BONUS ENTRY

Disclosures

Most States
OREGON RESIDENTS

This discount medical plan is NOT insurance, a health insurance policy, or a qualified health plan under the Affordable Care Act. The plan only provides discounts on medical services and equipment offered by providers who have agreed to participate in the plan. The range of discounts for medical services and equipment offered under the plan will vary depending on the type of provider and medical services and equipment received. The plan does not make and is prohibited from making payments to providers for medical services or equipment received under the plan. The member is obligated to pay for all discounted medical services and equipment received under the plan, but will receive a discount on certain identified medical services and equipment from providers participating in the plan. The Discount Medical Plan Organization/Discount Plan Organization is Perfectly Protected Practice, Inc., 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232, membership@chirohealthusa.com. You may call 1-888-719-9990 for more information and to request a list of program providers and the providers’ city, state and specialty, located in your service area. You may also search for participating providers at www.perfectlyprotectedpractice.com. The plan is subject to fees, requirements, and restrictions as specified in the membership agreement and includes a 30-day cancellation provision. Note to MA consumers: The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. Not available for sale in the state of Washington.

If you cancel within the first 30 days after the effective date, you are entitled to a refund of membership fees paid. If you cancel after the first 30 days, you are eligible for a pro-rata refund of membership fees paid. If we cancel your membership for any reason, other than non-payment, you are eligible for a pro-rata refund of membership fees paid. Refunds will be issued within 30 days of cancellation. You may cancel by contacting us at 1-888-719-9990 or membership@chirohealthusa.com or Perfectly Protected Practice, Inc., 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232. Members receive at least 5% off usual and customary rates. Perfectly Protected Practice, Inc. does not guarantee the quality of the medical services or equipment offered by individual providers.

This discount medical plan is NOT insurance, a health insurance policy, or a qualified health plan under the Affordable Care Act. The plan only provides discounts on medical services and equipment offered by providers who have agreed to participate in the plan. The range of discounts for medical services and equipment offered under the plan will vary depending on the type of provider and medical services and equipment received. The plan does not make and is prohibited from making payments to providers for medical services or equipment received under the plan. The member is obligated to pay for all discounted medical services and equipment received under the plan, but will receive a discount on certain identified medical services and equipment from providers participating in the plan. The plan is subject to fees, requirements, and restrictions as specified in the membership agreement and includes a 30-day cancellation provision. Note to MA consumers: The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. Not available for sale in the state of Washington. The Discount Medical Plan Organization/Discount Plan Organization is Perfectly Protected Practice, Inc. (d/b/a ChiroHealthUSA), 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232, membership@chirohealthusa.com. You may call 1-888-719-9990 for more information and to request a list of program providers and the providers’ city, state and specialty, located in your service area. You may also search for participating providers at www.perfectlyprotectedpractice.com.

If you cancel within the first 30 days after the effective date, you are entitled to a refund of membership fees paid. If you cancel after the first 30 days, you are eligible for a pro-rata refund of membership fees paid. If we cancel your membership for any reason, other than non-payment, you are eligible for a pro-rata refund of membership fees paid. Refunds will be issued within 30 days of cancellation. You may cancel by contacting us at 1-888-719- 9990 or membership@chirohealthusa.com or Perfectly Protected Practice, Inc., 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232. Members receive at least 5% off usual and customary rates.

1307 Airport Rd N Ste 1A, Flowood, MS 39232 ● Phone: (888) 719-9990 ● Fax: (888) 685-2220 ● info@chirohealthusa.com
Office Hours: Monday – Friday 8:00 AM – 4:30 PM CST

1307 Airport Rd N Ste 1A, Flowood, MS 39232 ● info@chirohealthusa.com
Phone: (888) 719-9990 ● Fax: (888) 685-2220
Office Hours: Monday – Friday 8:00 AM – 4:30 PM CST

1307 Airport Rd N Ste 1A, Flowood, MS 39232
info@chirohealthusa.com
Phone: (888) 719-9990 ● Fax: (888) 685-2220

Office Hours:
Monday – Friday 8:00 AM – 4:30 PM CST

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