Forms

Here are forms and links you may need for your personal consultation with an LTC Specialist.

When applying for long-term care insurance, your health history is considered. We suggest you complete the confidential Health Screening Form in order for our LTC Specialists to assist you in finding the appropriate plan and insurance company.

Online Health Screening Form: You may access and provide your health information, privately and securely, through this link.

Health Screening Form (PDF): Print and fill out the health screening form, then return it to us at your convenience via fax, email, or mail.