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MasterCare Solutions, Inc.
10260 S.W. Greenburg Rd
Suite 375
Portland, OR 97223

P: 503.626.2213
P: 800.ASK.4LTC
F: 503.627.9997


Individual LTCI Quote Request

The following is a list of fields you need to complete in order for us to best serve your clients with LTCI comparison proposals from carriers.

Have you Pre-Qualified your client? If not, click here for a Health Questionnaire.

New Underwriting Tool: Genworth's eValuate

Fields marked with * are required.

Broker Information

Client Information


Spouse/Partner Information


Additional Information

Please list any medications, as well as significant health conditions, medical treatments, AND/OR hospitalizations in the last 5 years. Also note any additional comments about this plan and prospect.