Please complete all sections, then select Submit at the bottom of the final page to send back to us.

2% of survey complete.
Long-term care insurance is medically underwritten - meaning that in order to make the best recommendations, your financial advisor is requesting some preliminary health information to see what product and carrier may be most appropriate.
This health information will ONLY be used for the purpose of investigating LTC Insurance and will not be shared with anyone.  After we have reviewed your answers, we will delete your response.  if you are looking at LTC Insurance with a partner or spouse, they will need to complete a separate survey. This survey is not an application for insurance.
Any questions during the survey?  Call us at 877-949-4582 and ask for assistance with the Underwriting Partner Survey.
This survey is HIPAA compliant.
Please plan on 5 to 15 minutes to complete this survey.
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Question Title

* 1. Is it okay if we share detailed results with your advisor?