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PHC Feedback Form
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* Indicates required question
Name
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Your answer
Date of Birth
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Enter you DOB in dd/mm/yyyy format
Your answer
Contact Number
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Your answer
Town/City
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Your answer
Marital Status
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Yes
No
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Occupation/Profession
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State Govt. Employee
Central Govt. Employee
Salaried Employee
Business
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Monthly Income
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5,000 – 15,000
15,000 – 30,000
30,000 – 50,000
50,000 – 75,000
75,000 – 1,00,000
> 1,00,000
Having any medical insurance policy
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Yes
No
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What services or features impressed you most in UHC
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Free OP’s
Free IP up to 3 Lakhs
Free lab up to Rs. 1500
Equity shares
Death benefit of 10 Lakhs
Fast track services in SUITS network hospitals
All the above
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I/We agree to receive alert/awareness message from SUITS/SUF
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Yes, I agree
No, I disagree
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Feedback/Suggestions
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