The following is a list of fields you need to complete in order for us to best serve your clients with Hybrid and Combination proposal(s) from carriers.
Have you Pre-Qualified your client? If not, click here for a Health Questionnaire.
Fields marked with * are required.
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.
10300 SW Greenburg Rd Suite 380
Portland, OR 97223
We desire to help you find the best long-term care insurance solutions for your clients.