22 Mill St. #410, Arlington, MA 02476, Voice 800 700-7505 Fax 781 643-2775
lgcorsetti@doukakiscorsetti.com
Index to Medical and Avocation Questionnaires
Many times, we receive inquires from agents that do not know or understand their client's medical information. These agents have a very low placement ratio vs. the knowledgeable agent.
The medical and avocation questionnaires linked on this page along with the underwriting information page are specifically designed to assist us and our underwriters determine a fair and accurate preliminary indication as to what company, plan of insurance, rating, etc. to offer you and your client. Please complete them as best as you can and either submit them or print and e-mail them to Best Marketing USA at 781 643-2775. If you have any questions, please e-mail us or call us at 1-800-700-7505 toll free.
All preliminary offers are subject to complete underwriting standards based on a current APS, Blood, HOS, EKG or any other testing or information deemed necessary by the underwriters to complete the underwriting process.
Always complete the Underwriting Information Questionnaire first, this form asks many general questions.
Medical Questionnaires:
Alcohol and Drug / Anemia / Angina / Angioplasty / Aortic Valve Disorders / Arrhythmia - Irregular Heart Beat / Arthritis / Back Disorder / Breast Cancer / Bypass - CABG / Coronary Artery Disease / Cancer / Cerebral Vascular-Neurological / Colon - Colorectal Cancer / Depression / Diabetes Mellitus / Immunodeficiency / Epilepsy - Seizure Disorder / Headache / Heart Attack / Hepatitis / Kidney Disease / Liver / Liver Enzymes / Lupus and Connective Tissue / Mitral Valve Disorders / Multiple Sclerosis / Murmur - Heart / Nervous Disorders-Dementia / Pacemaker / Peripheral Vascular Disease - Neuropathy / Prostate Cancer / Pulmonary Disease / Sleep Apnea / Testicular Cancer / TIA-CIA/Stroke / Ulcerative Colitis - Crohn's Disease
Special Applications:
Special Application Questionnaire (age 70 and over)
Foreign Nationals - Foreign Travel
Avocation:
Auto Racing / Aviation / Mountain Climbing / Scuba / Sky Diving
Underwriting Information Questionnaire
