Please fill in this form and Press the Submit button at the end. Thank You!
*Mandatory Fields
   
1.
   Name of respondent*
2.
   Enter Age*
3.
   Enter Place of Stay*
4.
   Education
5.
   Marital Status
6.
   Employment Status
7.
   Currently Staying in
8.
   Are you willing to live in a Senior Care Project?
9.
   If 'yes' when would you like to move in a Senior Care Project?  
   
10.
   Which of these amenities you desire? (Tick your choices)
   
24X7 Security Cable TV/ DTH Club House
Dining Facility Cards & Indoor Games Room Library
Reading Room TV Room Activity Centre
Medical Centre Emergency Care Open Air Theatre
Gymnasium Swimming Pool Tennis
Indoor Badminton Yoga Centre Ayurvedic Massage
Amphi Theatre Geriatric Hospital Assisted Care Facilities
Care for Dementia & Alzheimer Doctor & Nursing Care Broad Band
WI FI Arrangements Medical Shop Convenience Store
Business Centre        
Any other (Please Specify)    
       
11.
   Which of the following services you desire? (Tick your choices)
   
Catering Services House Maids Gardeners
Garbage Cleaning Travel Services Tours and Picnics
Recreation Arrangements Movies and Outings Periodic Medical Checkup
Talks on Religion,Spiritualism, General Topics Medical Supply Banking Facilities and ATM
Bill Payment Services Laundry Routine Checkup by Electrician & Plumber
Tax Consultancy        
Any other (Please Specify)    
       
12.
   What type of Dwelling you need? (Tick your choices)
   
Studio Apartments 2 Bedroom Apartments Villas
       
12A.
   What type of Dwelling you prefer ( in Sq.Feet)?
   
Studio Apartments 700 800
2BHK Apartments 1000 1100 1150
Villas 1400 1500 1650
       
13.
   You prefer the Dwelling
       
14.
   Would you prefer us to do the interior of your Dwelling?  
       
15.
   Would you like to live in a Senior Care Project in:  
   
Chennai Pune Bangalore
Hosur Coimbatore    
Any other (Please Specify)    
       
16.
   What model of ownership would you prefer?
       
17.
   Can we send you the information when we launch a project in a city of your choice?  
       
18.
   If Yes, Please give the following details:  
       
   
Address*
 
 
City*
Pin Code
Land Line Contact Number
Mobile Number*
Email ID*
Alternate Email Id
       
19.
   Would you like to give any suggestions for our consideration? (Max 2000 words)
       
    We thank you for your time and for your valuable inputs.
     
    Colonel (Retd.) A.Sridharan, VSM

M/S Covai Property Centre (India) Private Limited
727, Damu Nagar,
Puliyakulam Main Road,
Coimbatore 641 045
     
   
Tel: 0422 2312367, 6572625 Mobile: 98943 17841
Email: covaiprop@vsnl.net Email: covaiproperty@gmail.com
Web: http://www.covaiprop.com