The Hong Kong Mental Morbidity Survey for Older People - Reply slip
1. Serial Number (Shown on the right hand corner of address lable on the invitation letter)
*
2. Please select:
*
2. Please select:
I would like to participate.
I would like to know more about the study.
I refuse to participate in the study.
There is no one aged 60 or above living in my household.
3. Number of resident aged 60 or above in my household: (Data for statistical purpose)
*
3. Number of resident aged 60 or above in my household: (Data for statistical purpose)
One
Two
Three or above
4. Title:
*
4. Title:
Mr.
Mrs.
Miss
5. Name
*
6. Contact number
*
7. Preferred contact method:
*
7. Preferred contact method:
Phone call
Whatsapp
8. Upon the completion of the interview, you will receive HKD 200 supermarket cash coupon as a token of our gratitude.
Please select your preferred options:
*
8. Upon the completion of the interview, you will receive HKD 200 supermarket cash coupon as a token of our gratitude.
Please select your preferred options:
$50 ParkNShop supermarket coupon (4 pieces)
$50 Wellcome supermarket coupon (4 pieces)
Disclaimer
This form is owned by The Hong Kong Mental Morbidity Survey for Older People.
Please send comments and enquiries related to the form to
here
.
If you find the form is in violation of the
Terms of Service
, please let us know
here
.