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What is your gender?
 
Male
 
Female
 
 
 
What is your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
Do you suffer from any chronic conditions?
   
 
 
 
What additional services you could benefit from other than your current medical services.
   
 
 
 
What do you need from your health insurer to feel they are your healthcare partner (as members and not employees)
   
 
 
 
What is the best way to communicate with you
 
SMS
 
Email
 
Telephone
 
Other