Long Term Care Program

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

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


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


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.

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

Direct: 312-977-0024

Toll-free: 877-977-0125

Fax: 312-977-0128