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Quote Hospital Plans

Quote Hospital Plans Form:
Medical Aid Assist has qualified medical aid consultants that can assist you in deciding on the Hospital Plans that will best suit you and your family’s needs. 
This is a no obligation FREE Quote
Please complete the form below and let us know what options you are interested in and we will call you back.
[contact-form subject=”Hospital Medical Aid Quote” to=”forms@carelinegroup.co.za”] [contact-field label=”Full Name and Surname:” type=”name” required=”true” /] [contact-field label=”Email:” type=”email” required=”true” /] [contact-field label=”Cellphone Number:” type=”text” required=”true” /] [contact-field label=”Landline Number:” type=”text” required=”true” /] [contact-field label=”Town / City:” type=”text” required=”true” /]
Please let us know what options you’re interested in: 
[contact-field label=”Select Preferred Medical Aid Option” type=”select” options=”Not Sure,Medihelp, Dimension Prime 1,Fedhealth, EntryZone,Fedhealth, Maxima Core,Fedhealth, Maxima Basis,Compcare, Axis,Compcare, Axis Netcare,Discovery, Essential Core Series ,Discovery, Classic Core Series ,Discovery, Essential Core Delta Series ,Discovery, Classic Core Delta Series ,Resolution, Hospital Option,Liberty Health, Gold Focus Select ,Liberty Health, Gold Focus,Liberty Health, Platinum Focus,Pharos Medical Plan, Footprint Primary,Pharos Medical Plan, Rainbow Primary,Medshield, Core Plus,Spectramed, Aqua,Bonitas, Essential,Momentum, Custom Option (Any/Any),Momentum, Custom Option (Any/Associated),Momentum, Custom Option (Any/State),Momentum, Custom Option (Associated/Any),Momentum, Custom Option (Associated/Associated),Momentum, Custom Option (Associated/State)” /] [contact-field label=”Select Second Medical Aid Option” type=”select” options=”Not Sure,Medihelp, Dimension Prime 1,Fedhealth, EntryZone,Fedhealth, Maxima Core,Fedhealth, Maxima Basis,Compcare, Axis,Compcare, Axis Netcare,Discovery, Essential Core Series ,Discovery, Classic Core Series ,Discovery, Essential Core Delta Series ,Discovery, Classic Core Delta Series ,Resolution, Hospital Option,Liberty Health, Gold Focus Select ,Liberty Health, Gold Focus,Liberty Health, Platinum Focus,Pharos Medical Plan, Footprint Primary,Pharos Medical Plan, Rainbow Primary,Medshield, Core Plus,Spectramed, Aqua,Bonitas, Essential,Momentum, Custom Option (Any/Any),Momentum, Custom Option (Any/Associated),Momentum, Custom Option (Any/State),Momentum, Custom Option (Associated/Any),Momentum, Custom Option (Associated/Associated),Momentum, Custom Option (Associated/State)” /]  [contact-field label=”Select Third Medical Aid Option” type=”select” options=”Not Sure,Medihelp, Dimension Prime 1,Fedhealth, EntryZone,Fedhealth, Maxima Core,Fedhealth, Maxima Basis,Compcare, Axis,Compcare, Axis Netcare,Discovery, Essential Core Series ,Discovery, Classic Core Series ,Discovery, Essential Core Delta Series ,Discovery, Classic Core Delta Series ,Resolution, Hospital Option,Liberty Health, Gold Focus Select ,Liberty Health, Gold Focus,Liberty Health, Platinum Focus,Pharos Medical Plan, Footprint Primary,Pharos Medical Plan, Rainbow Primary,Medshield, Core Plus,Spectramed, Aqua,Bonitas, Essential,Momentum, Custom Option (Any/Any),Momentum, Custom Option (Any/Associated),Momentum, Custom Option (Any/State),Momentum, Custom Option (Associated/Any),Momentum, Custom Option (Associated/Associated),Momentum, Custom Option (Associated/State)” /] [contact-field label=”How did you find us?” type=”select” options=”Google,Flyer,Internet,Referral,Forum,Newsletter,Other” /] [/contact-form]