Awesome! Completing this form will only take about 2-3 minutes. Before we continue, how do you want us to address you? ^*

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Hi, ___ ! We appreciate your interest in Pilgrim Health. Please share with us your full name and contact details. ^*

First Name ^*

Last Name ^*

E-mail Address ^*

Mobile Number ^*

Home Address ^*

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Thanks for sharing! Do you have any preferred communication channels? ^*

Email

SMS / Text Message

Viber

Other

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Great! After you complete this form, we will be contacting you right away about the next steps. Are you signing up for anyone else? ^*

Just me!

I'm signing up for my family

I am exploring enrolling our employees

For both our household and our business

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Love that you are proactively taking care of your health and well-being! Can you share with us more about your motivations for signing-up? ^*

/

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Love it! We actually hope to partner with business owners who are looking to provide better health care benefits to their employees. What is the name and nature of your business? ^*

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Love it! We actually started Pilgrim Health because we also experienced the struggles of managing the health of our own household. How many household members do you have? ^*

Please also include yayas, helpers, drivers, and even family members who might not be living in the same household.

0-2

2-5

5-10

>10

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Love that you are thinking of enrolling not just your household but also your business, too! What is the name of your business? ^*

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Knowing more about your business helps us serve you better. How many employees does your company have right now? ^*

Please include both regular and part-time/contractual staff. We will use this information in creating a proposal for you.

0-10

10-20

20-100

>100

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What is your set-up like? Choose the one that best applies to your situation. ^*

Although we are a virtual clinic, we also offer site visits for employee onboarding, lectures, and workshops.

We have 1 physical office or store

We have multiple locations

We operate on a purely WFH set-up

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Where is your main office located? ^*

If you are within Metro Manila, we may be able to arrange onsite employee onboarding in your office or establishment.

For businesses outside Metro Manila, we hold employee onboarding sessions via Zoom.

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Ok, now let's move on to your household :) How many household members do you have? ^*

Please also include yayas, helpers, drivers, and even family members who might not be living in the same household.

0-2

2-5

5-10

>10

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Managing a household is no easy feat. We are here to help :) Can you share more about your motivations for signing up? ^*

Please tell us more about any health care challenges you have encountered.

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Managing a business is no easy feat. We are here to help :) Can you share more about your motivations for signing up? ^*

Please elaborate on the health care challenges you've encountered in the workplace, or your vision for the health of your team.

/

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Managing a business and a household at the same time is no easy feat. We are here to help :) Can you share more about your motivations for signing up? ^*

Please elaborate on the challenges you've encountered in your health care journey, including managing the health of the people around you.

/

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We’d love to get to know our audience better. How did you hear about us?

Personal contact

Facebook

Instagram

Online search (e.g. Google, Bing, etc.)

Other

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Thank you for sharing. We are very excited to guide you in your health care journey. Before we end this, do you have any more questions for us?

Please do share any comments or questions that you might have for us, and we'll do our best to address all of them :)

/

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Congratulations, ___! You have completed our sign-up process.

We look forward to guiding you in your health care journey. Our team will review your submission and get back to you within 1-2 working days. :)

Talk again soon!

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Pilgrim Health is a membership-based virtual clinic. Our aim is to keep our members happy, healthy, and out of the hospital! Would you want to sign-up to be a member?

Congratulations, ___! You have completed our sign-up process.