Heart Valve Surgery Life Insurance Quote Request

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Click next > and take 2 minutes to complete this SSL secure form and we will shop with over 121 different insurance companies and then email you with best offers.

Since 1969 We have helped hundred's of people with heart valve disease get the best rate possible.

We will do the exact same thing for you!

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State of Residence* This field is required.
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Alabama
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Washington
West Virginia
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Wyoming
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Gender* This field is required.
Female
Male
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Date of Birth* This field is required.
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Coverage Amount* This field is required.
$450,000
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Less Than $25,000
Other Amount
$25,000
$50,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$950,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$5,500,000
$6,000,000
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Insurance Type* This field is required.
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Please Select
Term Life Insurance
ROP-Return of Premium Term Life
Universal Life Insurance
Whole Life Insurance
Not Sure Yet
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Term Length
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Please Select
Not Sure Yet
5 Year Term
10 Year Term
15 Year Term
20 Year Term
25 Year Term
30 Year Term
Greater Than 30 if Available
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Do You Currently Have Life Insurance?* This field is required.
Yes
No
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Are You Looking to Replace This Policy?
Yes
No
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Height* This field is required.
Please Select
Please Select
4'-11"
5'-0"
5'-1"
5'-2"
5'-3"
5'-4"
5'-5"
5'-6"
5'-7"
5'-8"
5'-9"
5'-10"
5'-11"
6'-0"
6'-1"
6'-2"
6'-3"
6'-4"
6'-5"
6'-6"
6'-7"
6'-8"
6'-9"
6'-10"
6'-11"
7'-0"
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Weight (in pounds)* This field is required.
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Do You Smoke or Use Tobacco or Nicotine in ANY form?* This field is required.
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Please Select
Never
Cigarette Smoker
Quit Smoking
Cigar-Celebratory Cigar
Cigar-Occasional
Cigar-Daily
Chewing Tobacco
Marijuana
Other Tobacco or Nicotine Products
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How Long Since You Quit?Did you know that most companies will consider you to be a smoker for 12-24 months after you quit...It is also important to note that the non-smoker rate classes will vary by company and time since you quit.
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What Do You Use?
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Do You Take Any Medications?* This field is required.
Yes
No
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Please include medication name, dosage and frequency takenDon't worry if you do not have exact spelling. It's most important from underwriting standpoint to know why you are taking something.
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What heart valve surgery have you had? Click all that apply* This field is required.
Mitral Valve Repair
Mitral Valve Replacement
Aortic Valve Repair
Aortic Valve Replacement
Tricuspid Valve Repair
Tricuspid Valve Replacement
Pulmonary Valve Repair
Pulmonary Valve Replacement
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Date of heart valve surgery?* This field is required.
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Please provide details of your surgery:* This field is required.
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Have follow up echocardiograms and cardiac testing been normal/good since surgery?* This field is required.
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Do You Have Any Other Past or Present Health/Avocation Issues?
Cancer
Stroke/Mini Stroke
Diabetes
Depresion, Anxiety, Other Mental Health Issues
Kidney Disease
Liver Disease
Sleep Apnea
Alcohol/Substance Abuse
Scuba Diving, Private Pilot, Other Hazardous
Other Cardiac issue
Other Issue
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Details to Above Health/Avocation Issues
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Are You Currently Disabled?
Yes
No
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Name* This field is required.
First Name
Last Name
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E-mail* This field is required.
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Phone # (not required, please provide if you prefer call or text)
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Unique ID Number
Should be Empty: