Employer Fast Track Enquiry Form
 

Simply complete the data sheet below and select “Submit Advice Form” to send the results to Health Link Consultants. All information received is treated as confidential (refer to our Privacy Policy). If you prefer not to use the internet, please print this page then fax or mail it to us.

Remember, you must be authorised or have obtained the consent of your employer for the supply of data information to us. We will be in contact with your employer and will need to confirm that you were the contact person and provided these details to us.

On receipt of the details, we will prepare a written proposal for a Corporate Health Care Plan. there is no initial charge for this service. Should your employer wish to proceed with the plan, then we will completely arrange the introduction, implementation and all on-going advice and service for the plan.

Contact Details

 
Your Title
 
Your Name
 
Authorised Contact Title
 
Authorised Contact Name
 
Contact Phone
 
Fax Number
 
Business Address
 
Email Address
 

Business Details

 
Business Name
 
Business Type
 
Number of Employees
 
Number of Single Employees
 
Number of Couples Employees
 
Number of Family Employees
 
Payroll Frequency
 
If other please specify
 

Existing Health Insurance Plan

 
Do you have an existing Employer Health Plan?
 
If YES please fill in the details below. If NO skip to the next section
 
Name of Health Fund
 
Number of Employee Members
 
Does Employer subsidy apply?
 
Basis of Subsidy
 

Options for New Plan

 
Proposal Options
 
Proposed Level of Employer Support
 
Preferred Contact Basis
 
Preferred Follow-up Basis
 

Additional Information

 
Please provide any extra information or queries in this text box.