Survey — XiLema Holdings Group

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Please respond to this brief 5-question survey below. Your participation is greatly appreciated.

[1] Male/Female *

Please choose one.

[2] Age *

Please select range.

[3] Which (TOP 3) healthcare benefits are most important to you? *

Please select top 3.

Lab Tests

Birth control

Annual vision

Prescriptions

Dental cleaning

Urgent care visits

Emergency room visit

Vitamins & supplements

Annual primary care visit

Not more than $30 copay for medication and doctor visits

Holistic medicine - chiropractor, aroma therapy, CBD, acupuncture, etc.

[4] How much are you willing to pay every month for the 3 benefits you listed above *

Please select payment range below.

[5] Do you currently have health insurance? *

Please select one.

Thank you so much for participating in this brief survey.

XiLema Holdings Group

5090 Richmond Ave #163
Houston, TX 77056

(888) 724 1231