Why Does This Matter?

Even if perfectly healthy, the odds that you fall ill with a life-threatening condition in your lifetime are higher than not. Unless you prematurely pass away by accident, serious illness is your likeliest affliction. Insurance companies know this. They also know that you will likely survive your first bout with serious illness.

Find out if you qualify for critical illness insurance

Qualification Questionnaire

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Name

First

Last

Phone

Age

Gender

Female
Male
Other

Tobacco Consumption

Height

Weight

Name

Disclosure

This medical questionnaire is not an application for health or life insurance. It used by your Red Helm Insurance advisor to help you determine which plan is most suitable for you. Your health information will not be shared with any 3rd party and is strictly used to provide advice related to the application of life or health insurance.

Critical Illness Insurance - Qualification Questionnaire

Why Does This Matter?

Qualification Questionnaire

Have you ever sought advice or received any treatment for, or had any known indication of:

In the last 5 years, have you been diagnosed or had any known indication of a medical problem involving:

Have you ever sought advice or received treatment for, or had any known indication of:

Do you currently:

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