WELCOME TO THE WEBSITE OF
MEDCON
MEDICAL AID CONSULTANTS
Name:
Surname:
E-mail:
Contact Number:
Please complete questionaire:
Are you currently on a medical aid?
Yes
No
If yes, name =
option =
Number of dependants?
Do you or your spouse earn less than R5500pm?
What is your age?
Number of years you have been on a medical aid?
Do you use chronic medication?
Yes
No
Are you prepared to use a network doctor?
Yes
No
Additional Comments:
If you require GAP cover please provide the name of your current medical aid and option.
Authorised Financial Services Providers- FSB no' 25217
Council of Medical Schemes accreditation no' ORG2458
