Complete Our Medical Travel Monitor Survey and be entered to win a $100 Amex Gift Check.

Help us learn more about medical travel and medical tourism. Please take the opportunity to take a brief survey, which will inform our future issues on this topic.

Thanks for your interest in participating in our Medical Travel Monitor Survey. Please answer the following questions and provide us with your contact information. One name will be randomly selected from all the completed survey received to win a $100 Amex Gift Check.
1. Would you travel outside the United States for...(check all that apply)
Bariatrics (weight-loss surgery) Neurologic surgery
Cardiac Surgery Oncology (prostate cancer treatment)
Cosmetic Surgery Organ Transplant
Dental Care Orthopedic Surgery
In-vitro Fertilization (IVF) Stem Cell
 
2. What destinations are most appealing when it comes to healthcare overseas?
Argentina Malaysia
Brazil Mexico
Caribbean Islands New Zealand
China Panama
Guatemala Philippines
India Singapore
Israel South Africa
Korea Thailand
Other:
 
3. In what city/state/province/region and country are you located?
 
4. In what US city would you be most likely attend a medical expo or conference on medical travel and medical tourism? (Check all that apply)
Albany, NY Newport Beach, VA
Atlanta, GA Oklahoma City, OK
Baton Rouge, LA Phoenix, AZ
Cincinnati, OH Portland, OR
Dallas/Austin, TX Sacramento, CA
Lakewood, NJ San Diego, CA
Louisville, KY Seattle, WA
Miami, FL Tallahassee, FL
Nashville/Memphis, TN Tampa, FL
New Orleans, LA Washington, DC
New York, NY  
 
6. Do you have adequate health insurance? Yes No
 
7. Are you eligible for Medicare/Medicaid? Yes No
 
5. What is your personal annual salary range?
$0 - $25,000 $25,000 - $50,000
$50,001 - $75,000 Over $75,000
*Name:
*Title:
*Company:
*Address:
Address 2:
*City:
*State/Province:
*Postal Code:
*Country:
*Gender: Male Female
*Marital Status: Single Married
*E-mail:
* Required fields