Official Survey of the Medical Tourism Magazine

1.

The results of the survey will be published as a Country and Region report, where all respondents answers will be combined together without identifying the contact details of those organizations who filled out the survey. Therefore your individual answers and details of this survey will be kept strictly confidential and will not be identified with your organization under any circumstance. As a participant in the survey you will have access to a summary and analysis of the survey. This survey is part of a comprehensive survey the MTA and Medical Tourism Magazine are conducting that will be published in 2011 as part of the MTA Medical Tourism 2010/2011 Research Report. Please be as detailed as possible in your answers.

Question Title

* 1. Please Note: Your Contact information asked of below, WILL NOT be identified in the report and is only collected to verify internally the source of the respondent and verify the authenticity of the answers.

First Name: *

Last Name *

Company:

City/Town: *

State/Province:

Country: *

Email Address: *

Phone Number:

Question Title

* 2. Please select your organization type:

Hospital or Clinic

Doctor

Governmental Organization

Medical Tourism Facilitator

Travel Agent

Medical Tourism Consultant

Employer - Benefits Manager/Human Resources

Insurance Agents/Consultants or Broker