Impaired Risk Life Insurance Questionnaires

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We’re high risk life insurance specialists and have collected mounds of impaired risk resource materials since 2005.

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 questionnaires, they are only guessing what your rates will beProceed 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