Online Health Consultation Service (TeleMed) Needs Assessment Form for Foreigners Living in Indonesia
Sec 1 is for respondents basic information
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Can you tell us the first letter of your name (from A-Z)?
How do you describe your gender?
Clear selection
How old are you? *
Where do you come from? *
Which city in Indonesia are you staying at? *
How long have you been staying in Indonesia? *
How long do you plan to stay in Indonesia? *
Are you an expatriate?
Clear selection
How is your ability to speak Bahasa? *
How is your ability to speak English? *
Clear form
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