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Index to Printable Medical and Avocation Questionnaires
PDF format ready to print
The medical and avocation questionnaires linked on this 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 IPA at 781 643-2775. If you have any questions, please e-mail us or call us at 1-800-700-7500 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.
Adobe PDF Medical Questionnaires:
Alcohol / Alzheimer / Anemia / Anxiety / Arthritic / Back / Cardiovascular / Cerebral Vascular / Crohns / Diabetes / Drug / Emphysema / Epilepsy / Gastro / Headache / Hepatitis / Hypertension / Immunodeficiency / Kidney / Liver / Loss of Weight / Lupus / Overweight / Peripheral Vascular / Respiratory / Tobacco Use
Please note that these forms are general in nature and can be used for other related diseases example: Cerebral Vascular and stroke (TIA/CVA). We will also be adding new questionnaires as they become available to us.
Life Insurance Proposal Request Form
Long Term Care Proposal Request Form
Disability Proposal Request Form
Underwriting Information Sheet
