Survey-BS – 031 Consulting

Full Name *

First and Last Name

Email *

Select your call preference *

Video Skype call

Audio Skype call

Phone call

Phone number & Skype ID (If you asked for a Skype call) *

Type your phone number or Skype ID

Your Monthly Gross Income *

Less than R20,000 per month

R20,000 - R35,000 per month

R35,000 - R50,000 per month

R50,000 - R80,000 per month

R80,000 - R120,000 per month

R120,000 - R200,000 per month

R200,000 or more per month

Do You Currently Have Medical Aid Cover

Yes

No

What Do You Believe Is The State Of Your Medica Aid Cover

I have no medical aid cover

I have medical aid cover but it's not enough

I have sufficient medical aid cover, but I want to get more information

What Time Of Day Is Best For Me To Call You.

Morning (08:00 - 12:00)

Lunchtime (12:00 - 13:00)

Afternoon (13:00 - 17:00)

Evening (17:00 - 18:00)