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.
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