Impairment Questionnaires

Position yourself for success by asking key medical questions before providing a quote. 

Health Questionnaire     HIPAA Form  

In addition to the general health questionnaire, the below questionnaires may be helpful for clients with a specific impairment.

Return completed questionnaires to your Bellevue or Portland servicing office & we’ll recommend the most competitive carrier based on your client’s unique medical history.

Impairments: