Examination… Diagnosis… Prescription…
Answering the questions below is necessary to examine your needs, wishes, requirements and problems concerning your health care cover. On the basis of your answers, I shall make a diagnosis and give you my prescription as to what you must do. With clarity, sincerity and absence of hype, so that you can make an informed decision.
Please answer all the questions, in the blank spaces, giving full particulars. If something is not applicable, type N/A. When done, click Send at the bottom hereof.
The contributions of many options are based on monthly income. This provides an opportunity for lower income earners to obtain excellent cover at really affordable contributions per month. Therefore, the two questions below regarding gross income, if below R15 000 per month.
I treat all your information with the utmost professional secrecy.
You hereafter means not only yourself, but also each of your dependents you wish to register under your membership.
Needs analysis Questionnaire
I will be in touch with you real soon.
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053 531 0003 Office
053 531 0123 Office
082 953 3222 Cellphone (24 hours)
086 671 2107 Fax
PO Box 123 / 8 Karee Street BARKLY WEST 8375
On the banks of the Vaal River, 35 km from Kimberley
Always as near to you as the nearest phone or computer
Language Editor Dr. Lariza Hoffman
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