Call us at
(866) 868-0099

LifeInsure Rate Class Health Quiz

Discover Enormous Savings on Your Life Insurance Policy!

Different carriers have unique underwriting niches. We find you the best rate classification, resulting in thousands of dollars in savings over the life of your policy. Our process ensures you get the best option in minutes!

Take the Health Quiz Below and Receive a Pre-Approval Email in Minutes!

**This information is NOT shared, and is used specifically to isolate proper rate class which will determine YOUR price and best insurance provider!

LifeInsure Rate Class Health Quiz

"*" indicates required fields

Legal Name*

First Last

Gender*

State*

Email*

Phone Number*

Date of Birth*

Smoking/Tobacco Use*

Marijuana Use*

If Yes to Marijuana - How many times per month

Height*

Weight*

Have you lost more than 10 lbs in the last 12 months?*

If Yes to above question, how much did you lose?

Any treatment for high blood pressure?*

Any treatment for elevated cholesterol?*

Heart problems or irregular heart beat?*

History of stroke, mini stroke or blood clots?*

History of Diabetes or elevated blood sugar?*

If Yes to Diabetes, your last a1c reading (if known)

If Yes to Diabetes, any teatment?

Any rorm of cancer or tumor?*

Details, if Yes to cancer or tumors

Any ussues with Asthma or respiratory ailments?*

Details, if Yes to Ashtma or respiratory ailments

Sleep Apnea?*

If Yes to Sleep Apnea, do you use a Cpap Machine?

Diagnosed with Anxiety or Depression?*

If Yes to Anxiety or Depression, current treatment (including medications)?

History of Alcohol or Drug Abuse*

If Yes to Alchohol or Drug Abuse, date oflast treatment?

Any Issues with the Liver or Kidneys?*

List Current Medications

Any Immediate Family Deaths prior to age 65?*

Driving History - any moving violations in last 5 Yyars?*

Driving History - any DUIs or Reckless Driving?*

US Citizen?*

Do you have any intention to live outside the US in the next 2 years?

Active Duty in the Military or Military Reserves?*

Life Insurance Ever Been Rated, Canceled, Postponed or Declined?*

Any life insurance applications pending with any other company?*

Have you ever declared bankruptcy?*

Have you ever been convicted of a misdemeanor?*

Have you ever been convicted of a felony?*

How much life insurance do you need (death benefit)?*

Term Length*

Comments

This field is for validation purposes and should be left unchanged.

Call us at
(866) 868-0099

LifeInsure Rate Class Health Quiz

LifeInsure Rate Class Health Quiz

Your information is secure with us. No spam – just your free guide."

Life Insurance Doesn't Have to Be Confusing!

Call us at (866) 868-0099

LifeInsure Rate Class Health Quiz

LifeInsure Rate Class Health Quiz

Get Your Free Guide – Simplify Life Insurance Today!"

Your information is secure with us. No spam – just your free guide."

Life Insurance Doesn't Have to Be Confusing!

Call us at
(866) 868-0099