YES or NO
Do you want ONLY hospital cover?
YES or NO I want doctor, chemist, dentist and glasses.
How many adults?
Total number of years (from age 35) you have been a medical aid member
Your Partner's age
Total number of years (from age 35) your partner has been a medical aid member
How many children?
Your current medical aid and plan
How much can you spend a month?
Any chronic conditions?
What do you want from a medical scheme?
I confirm that I have read and understood the notes below and agree to further communications sent to me. Yes
Last update: December 7, 2019
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