Medical Questionnaire

In order decide which insurance company to place disability insurance with, health history should be accounted for up-front.  Pricing and availability of features depend on individual health history, and carriers can have variable risk appetite for any given condition.
 

Do not complete this form without first completing the initial intake process, which is the basis for determining what you need.  To do so, call or use the intake form.
 

This will not be shared. No carrier will see it.

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Good To Know:

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• In the interest of privacy, there are no personal identifiers and this is to be completed off-line.

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• Download it to a location where you can  easily come back to it later and work off of that.  It may take 30 minutes or so, and you may need to take intermissions.

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• As you decide whether to check yes or no, err on the side of disclosure knowing this questionnaire is off-the-record. The official health statement that would be filed with any future application doesn't necessarily have to mirror your answers here.

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• If you're not sure about something, just write "call" to flag it for future discussion.

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• For extra privacy, don't submit it.  Instead, use this as a checklist of things to discuss over the phone.  Submission is optional.