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Impaired Risk Life Insurance Questionnaires

Below you'll find an alphabetical list of questionnaires for specific health conditions.  They will download as a PDF for you to print or save.

These questions contain the information we need to know for each health impairment in order to find the lowest rate. 

Tip: If an agent doesn't ask for the information in these questionaires, they are only guessing what your rates will be.  Proceed with caution. 

Arthritis
Asthma
Cancer - Bladder
Cancer - Breast
Cancer - Cervix
Cancer - Colorectal
Cancer - General
Cancer - Hodgkins-Lymphoma
Cancer - Leukemia
Cancer - Ovarian
Cancer - Prostate
Cancer - Skin
Cancer - Testicular
Cholesterol - Lipid
Colitis
Crohns Disease
Dementia - Alzheimer
Depression
Diabetes
Drug_Use
Epilepsy
Heart Attack
Heart - Abnormal EKG
Heart - Angioplasty
Heart - Aortic Regurgitation
Heart - Aortic Stenosis
Heart - Bundle Branch Block
Heart - Bypass
Heart - Cardiomyopathy
Heart - Congestive Heart Failure
Heart - General
Heart - Irregular Beat (Atrial Fibrillation)
Heart - Mitral Valve Prolapse
Heart - Mitral Valve Regurgitation
Heart - Mitral Valve Stenosis
Heart - Murmurs
Heart - Pacemakers
Heart - Pericarditis
Heart - Pulmonary Disease
Hematuria
Hemochromatosis
Hepatitis
Kidney Stones
Kidney - General
Kidney - Glomerulonephritis
Kidney - Proteinuria
Kidney - Renal Insufficiency
Liver Enzyme Elevations
Lupus
Multiple Sclerosis
Parkinsons
PSA_Elevation
Sarcoidosis
Sleep_Apnea
Stroke

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