Surveyor's Name
What is your name?
*
Your full name
How old are you?
*
Your age
Have you spoken to your family on how you would like your healthcare and welfare matters be managed in such a situation?
Yes
No
I'm not sure
Would you prefer to nominate a someone to handle your living matters, or let the courts appoint a deputy?
Self nominated
Court appointed deputy
I'm not sure
Would it be wiser to have your wishes made known or to leave it to others to make decisions for you?
Wishes made known
External opinions & decisions
I'm not sure
Do you think your current resources are sufficient to handle the financial impact of such a scenario?
Not sufficient
Adequate
I'm not sure
What would be a fair cost to do up an Advance Care Plan?
$250-$500
$500-$750
$750-$1,000
I'm not sure
As a token of appreciation, we would like to extend a gift for taking time to answer this survey.
*
$150 credits to use for ACP consultation
One pass to a Bequest seminars or movie event
My contact number
*
I consent that Bequest Pte Ltd and its affiliates may collect, use and disclose my personal data for purposes related to, but not limited to Advanced Care Planning. This may includes keeping me updated of any services that may be relevant to me; and for any compliance, marketing, audit and regulatory purposes.
*
Agree
Submit
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