Health Survey 2021
At KPJ Healthcare, we take pride in our role to improve your health, well-being and quality of life.

We would love to have a better understanding of your health needs. Please spare less than 10 mins to answer this short survey. Your valuable input will help us to improve our services at our hospitals and ambulatory care centres. Thank you.

#KPJCares
Sign in to Google to save your progress. Learn more
1. Business Name *
2. State
Location
3. Nature of Business *
4. Latest sales turnover *
5. Number of employees *
Overall Health Survey of Your Employees
6. In general, what type of services did your employees get in a clinic or hospital? Please check all that apply: *
Required
7. Do your employees currently suffer or are under monitoring from any hereditary conditions / diseases? Please check all that apply: *
Required
8. Have your employees had a positive test for Covid-19 within the last 6 months? *
If YES, approximately how many? Please check all that apply:
Clear selection
9. Which additional services would you look seek for the benefit of your employees? Please check all that apply: *
Required
10. Is your company medical covered under insurance? *
If YES, please select your provider: *
11. Does your employee benefit covers the following: *
If YES, please select the coverage amount: *
12. Is there any annual screening benefit allocated for your employees? *
If YES, please select allocation amount: *
Improving Your Experience
13. KPJ Healthcare is embarking on an innovation journey to improve your experience. Which of the following would you like to see implemented first? *
14. Would you like to hear from our doctors on the latest medical insights or webinars? *
If YES, how often?
Clear selection
15. Do you have any additional suggestions / feedbacks to improve our services? *
Contact Details
Full Name *
Designation *
Email address *
Please provide your email address to receive related promotions from us in the future.
Contact Number *
Please provide your contact number to receive related promotions from us in the future.
Personal Data Protection *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of KPJ Healthcare Berhad. Report Abuse