discovery health medical aid

DISCOVERY HEALTH MEDICAL AID QUOTE.


Please complete this form and send to me.
Get a quote on all the plan options, rates and information you need.

FULL PLAN DETAILS: DISCOVERY HEALTH MEDICAL AID

Check these PLAN BENEFIT VIDEOS:(they offer a brief benefit explanation of each plan).

DO YOU HAVE TO JOIN YOUR EMPLOYER'S MEDICAL AID? YES or NO

ONLY HOSPITAL COVER? YES or NO I WANT DOCTOR, DENTIST, CHEMIST, GLASSES AS WELL

NAME

EMAIL

TEL

CITY

HOW MANY ADULTS

YOUR AGE

PARTNER'S AGE

HOW MANY CHILDREN

YOUR CURRENT MEDICAL AID AND PLAN

TOTAL YEARS IN YOUR LIFE YOU HAVE BEEN A MEDICAL AID MEMBER

HOW MUCH CAN YOU AFFORD EACH MONTH

ANY CHRONIC CONDITIONS

WHAT DO YOU WANT FROM A MEDICAL AID

Are you interested in VITALITY subsidised gym membership, movie tickets, travel etc. YES NO

Receive my informative letter on personal financial matters? Yes

Please note:

I confirm that I have read and understood the notes above.Yes

Exclusions and sub - limits apply, see brochures.

Exclusions and sub - limits apply, see brochures.

discovery helpINVESTIGATE OTHER MEDICAL AIDS!

income protectionlife insurance quote peter pyburn brokerpeter pyburnemailpyburn@peterpyburn.co.za


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