Your Satisfaction is our #1 Priority!

The Provider Affairs Education Team wants to hear from the provider community. We are expanding our territory by offering educational opportunities throughout Illinois and bordering states. To ensure that we are meeting your needs with the selection of workshops in convenient locations within your community, we need your input on this survey.

If your staff consists of 20 or more people, we can customize an in-service workshop to accommodate your office.

Please complete the information below:

* - Indicates a required field.

Name and address of facility in your area willing to host this workshop

*Facility Name

*Address

*City

*State

*County

*Contact Name

*Contact Phone

*Email Address

Do our workshop topics meet your needs?

Yes No

If not, please specify the type of workshop(s) you would like to host:
 

Thank you for completing this survey!