Underwriting Solutions
Preliminary Inquiry Authorization Form - Complete and have client sign this form. Please send this to Underwriting Solutions with all available medical records and any other information that may effect your client's insurability for life insurance.
Medical Condition Questionnaires
Please complete each questionnaire that applies.
*Alcohol Abuse PDF
*Angina PDF
*Angioplasty PDF
*Anxiety Disorder PDF
*Arrhythmia PDF
*Asthma PDF
*Atrial Fibrillation PDF
*Breast Cancer PDF
*Build PDF
Use specific Cancers Questionnaires, if available: Breast, Hodgkin's, Leukemia, Lymphoma, Melanoma, Prostate, Skin - For other use General Cancer
*Cancer (General) PDF
*Cerebral Vascular Accident (CVA) PDF
*Chest Pains PDF
*Chronic Bronchitis (COPD) PDF
*Coronary Bypass PDF
*Depression PDF
*Diabetes PDF
*Discoid Lupus PDF
*Disseminated Lupus Erythematosis (DLE) PDF
*Emphysema PDF
*Epilepsy PDF
*Heart Attack PDF
*Heart Murmur PDF
*Hepatitis (Includes Hepatitis A, B, C) PDF
*High Blood Pressure PDF
*Hodgkin's PDF
*Hypertension PDF
*Irregular Heart Beat PDF
*Leukemia PDF
*Lymphoma PDF
*Lung Disease PDF
*Melanoma PDF
*Mitral Valve Prolapse PDF
*Multiple Sclerosis PDF
*Myocardial Infarction PDF
*Overweight PDF
*Parkinson's Disease PDF
*Prostate Cancer PDF
*Restrictive Lung Disease PDF
*Seizure Disorder PDF
*Skin Cancer PDF
*Sleep Apnea PDF
*Stroke PDF
*Systemic Lupus Erythematosis (SLE) PDF
*Transient Ischemic Attack (TIA) PDF
*Ulcerative Colitis PDF
*Valve Replacement PDF