1

CUSTOMERSS REVIEW, FOLLOW UP AND ACTIVATION RECORD

Id No: _______________________
Date of Birth: ___________
Name: _______________________
Gender: M/F
_______________________
Occupation:________________
Tel No: ______________________
Address: ___________________________________________________________
Best Visiting Time: ____________________________________
Product Consume/ Start(Date) : ____________________________________
Customers Health aim:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Follow up: 3 Months Programme
Week

1
2
3

Date

Details/Performance

Notes

2
7

10

11

12

Activation
Date: _______________
Referrals:
No

Name

Contact No

Background

3
No

Name

Contact No

Background