Health Insurance Survey

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This is the questionnaire that deals with health care and your involvement in health care. Please take a few minutes to express your opinions about the availability and quality of health care in your community. Your answers are important to the success of this study.

Thank you for your assistance.

Do you have ANY Critical Illness coverage policy?

YES

Does it covers 36 illness?

YES

NOT SURE

Which INSURANCE Company are you currently holding?

Which illness do you consider the NO.1 in Malaysia?

Stroke

Cancer

Heart Attack

Others

Contact Information

* First Name :

* Last Name :

Address 1 :

* Phone :

* Email Address :

Thank you for your assistance.