Long-Term Care Offering

a service of d.b.a. Burling Insurance Group Long Term Care

Long-Term Care Basics  |  Forms  |  Schedule an Appointment  |  FAQ  |  Meet the Team

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 confirm your eligibility for coverage. We will contact you for a phone consultation once you submit your information.


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



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


*The online form and PDF version ask the same health questions. Please choose whichever option you feel comfortable with to send us your health information.

If you have any questions, you may contact us at:

Direct: 312-977-0024

Fax: 312-977-0128