Step 1:

Complete our LTC

Pre-Appointment Survey

Please complete our LTC assessment to prepare for your appointment.

Let's get started!

Which state would you prefer to receive care in >

If care was needed tomorrow... select your means to fund the care.

Income? (Employment, SS, Pension, etc)

Checking / Saving / CDs?

Life Insurance - Cash Value?

Annuities / Other Investments?

Retirement Account? (IRA, 401k, 403b, etc)

Equity In Your Home?

Stocks / Bonds / Other Investments

What types of plans/features interest you?

> What types of plans/features interest you?

Assets Based plans that pay you back

Plans Guaranteed to never increases in cost

Plans with unlimited Lifetime benefit

Traditional Annual or Monthly Premium Plans

Great! Tell us about more about your health

> Do you smoke tobacco products?

Yes

No

> How tall are you?

> How much do you weigh?

Continued...

> Are currently taking ANY prescribed medications?

Yes

No

> Please List Your Current Medications Prescribed: Reason/Date Started Taking / Primary

> How long ago was your last physical with your primary care doctor?

Within The Past 2 Years

Over 2 Years Ago

> If it has been more than 2 years, please estimate how long ago you last went to the doctor or hospital and what the reason was.

> Do you have any surgeries or procedures planned?

Yes

No

Do you have any planned surgeries or procedures?

> Have you had any of the following conditions?

> Please list details of any conditions checked above:

Many of our asset based solutions will allow you to add your spouse/partner to the same policy.

> Do you have a spouse or partner?

Yes

No

> Spouse/Partner | Full Name

> Spouse/Partner | Date of Birth

Great! Tell us about more about your health

> Spouse/Partner | Do You Smoke?

Yes

No

> Spouse/Partner | Height

> Spouse/Partner | Weight

> Does your spouse/partner taking ANY prescribed medications?

Yes

No

> Spouse/Partner | Medications Prescribed: Reason/Date Started Taking

> Spouse/Partner | When was your last annual physical / check up with your primary care doctor?

Within The Last 2 Years

Over 2 Years Ago

> Spouse/Partner | If it has been more than 2 years, please estimate how long ago you last went to the doctor or hospital and what the reason was.

> Does your spouse/partner have any surgeries or procedures planned?

Yes

No

> Spouse/Partner | Have any planned surgeries or procedures?

> Spouse/Partner had any of the following conditions?

> Spouse/Partner | Please list details of any conditions checked above:

Almost finished...

How To Contact You

> First Name

> Last Name

> Mobile / Home Phone #

> Email *

> Let Us Know The Best Times To Call You?

Mornings | 9am - 12pm

Afternoons | 12pm - 5pm

Evenings | 5pm - 7pm

Anytime Is Okay

> Other concerns or comments for us

We look forward to assisting you!

> To submit your assessment check the box below

I agree that my information is being collected and stored and I am submitting my information to find out my options.

All information is confidential. We need this information in order to provide you with personalized information regarding the cost of LTC insurance. Under no circumstance will your information be sold.

Would you like help completing

your LTC survey ?

Let us help!

If you feel more comfortable having one of our specialist complete this assessment

with you or have questions click below and select a date and time that works for you.

Would you like our

help completing your LTC survey

Simply click below and select a date

and time that works for you.

Check Our Openings HereTo get started, schedule a free learning call.

A member of our team will contact you then to help you complete and submit

our questionnaire.

A member of our team will contact you then to help you

complete and submit our questionnaire.

OR

Give Us A Call

We look forward to assisting you with

your extended care planning needs!

Step 3:

Is a consultation meeting (virtual, phone or office) to review the LTC Cost

of Care Analysis.

The consultation is a time for us to present options, address questions and to ultimately help you develop an LTC strategy that meets your needs and resources.

Click Here To Get StartedTake Our 15 Minute LTC Pre Appointment Assessment

Step 3:

Is a consultation meeting (virtual, phone or office) to review the LTC Cost

of Care Analysis.

The consultation is a time for us to present options, address questions and to ultimately help you develop an LTC strategy that meets your needs and resources.

Click Here To Get StartedTake Our 15 Minute LTC Pre Appointment Assessment

Our Dedicated Team

Of Specialist Are

Here To Help!

If you would like to know

more about our unique

Long-Term Care solutions

OR

have questions about this

type of planning give us a call.

Need Help Designing Your Plan of CareTo get started, schedule a free learning call.

If you would like to know more about our unique

Short-Term & Long-Term Care solutions

or have questions about this type of planning give us a call.

Need Help Designing Your Plan of CareTo get started, schedule a free learning call.

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Office:

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