Medical Pre-Screening

This is a secure digital form where your information is completely safe and confidential. The number one goal of medical condition pre-screening to to eliminate surprises with the rates after you apply. Please complete these fields with your detailed information so we may review your case and find the most applicable life insurance company for your given health history. This will allow us to secure the lowest rates for you. Please be as detailed as possible in order for us to receive accurate rates from the multiple carriers we will request rates from.

Medical condition pre-screening is a very important step in securing the best life insurance rates you may qualify for. Having any serious health conditions could affect the final rates of your application. We want to limit the impact they may have on your premium. Investing 10 minutes worth of time in a simple pre-screen, can definitely help you secure the best life insurance rates possible. Click this link if you would like an instant life insurance quote.

The primary purpose of  a medical condition pre-screening is to predetermine what life insurance company will offer you the lowest premiums.

This is a simple and secure inquiry that helps to eliminate unforeseen changes in your health classification.

Your information is always secure and shared with no one for any reason.

Even the life insurance companies themselves will have no knowledge of your identity.

*Once this form is completed, all of the work is done entirely by your agent.

• First Name:*
• Last Name:*
• Email*
• Phone*
• State:*
• Zip Code:*
• Gender:*
  • Male
  • Female
• Date of Birth*
  Date Format: MM slash DD slash YYYY
• Height:*
• Weight:*
• Nicotine or Tobacco Use?*
  • Yes
  • No
• Please explain usage*
• Coverage Amount?*
• Term Length (in years):*
• Medical Conditions (please be as detailed as possible):
• Prescriptions:
• Comments:
• Phone
  This field is for validation purposes and should be left unchanged.

What type of medical conditions can impact my rates?

Medical conditions are otherwise known as health conditions. These could be conditions such as High Cholesterol, Hypertension (high blood pressure), Diabetes, Heart Conditions, Overweight & Obese conditions, Cancer, Anxiety, Depression, Epilepsy, Kidney Disease, Strokes, Asthma and many others. Medical condition pre-screening can save time and help find the best life insurance rates.

Hazardous occupations can also increase your life insurance premiums

Hazardous occupations such as Structural Iron and Steel Workers, Farmers and Ranchers including Agricultural Managers, Truck Divers, Drivers and Sales Workers, Construction Workers & Laborers, Refuse and Garbage Collectors, Electrical Power Line Repairmen & Power Line Installers, Roofers, especially the Commercial Roofer working with hot tar, Airplane Pilots and Helicopter Pilots along with Flight Engineers, Logging workers otherwise known as Loggers & Lumberjacks, Commercial Fisherman working in the oceans and a number of others.

Dangerous sports can also cause a high risk exposure increasing your rates

Some of these sports could be Scuba Diving, Sky Diving, Bungee Cord Jumping, White Water Rafting, Base Jumping, Bull Riding (Rodeo), Motorcycle Racing, Rock Climbing, Drag Racing, Boat Racing, Stock Car Racing, Private Airplane and Helicopter flying just to name a few.

Get an instant life insurance quote and compare the best life insurance rates from over 40 trusted life insurance companies.