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  5. Healthcare Survey EN
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Exit Survey
 
 
Gender:
 
Male
 
Female
 
 
 
Current Occupation:
   
 
 
 
Location of residence:
 
Beijing
 
Hong Kong
 
Shanghai
 
Other
 
 
 
 
Age:
 
below 25
 
25-35
 
35-45
 
45-55
 
above 55
 
 
 
Highest eduction achieved:
 
High school diploma
 
College graduate
 
Graduate school and above
 
Other
 
 
 
 
Marital status:
 
Single
 
Married
 
 
 
Do you have children in your household?
 
Yes
 
No
 
 
 
Age of child(ren) (if applicable):
   
 
 
 
Do you have elderly dependents in your household?
 
Yes
 
No
 
 
 
Age of Elderly Dependent(s) (if applicable):