Impaired Risk Questionnaires
Submit your impaired risk cases to our Underwriter using the forms at the links below: (1) Click on the link to the desired form, (2) Complete the fillable form electronically, (3) Save the completed form to your documents, (4) Attach the completed form to an email to Bill McGrory, Director of Underwriting: bmcgrory@globalinsurance.
- Alcohol
- Angioplasty
- Anxiety Disorders
- Arthritis
- Atrial Fibrillation
- Avocations
- Build
- Bundle Branch Block
- Cancer
- Cancer-Bladder
- Cancer-Breast
- Cancer-Cervical
- Cancer-Ovarian
- Cancer-Prostate
- Cancer-Skin
- Cancer-Testicular
- Cerebral Palsy
- Congestive Heart Failure
- COPD
- Coronary Artery Disease
- Coronary Bypass
- Crohn’s Disease
- Cushing Syndrome
- Dementia-Alzheimer’s
- Depression
- Diabetes
- Down Syndrome
- Driving
- Drugs
- Eating Disorders
- Emphysema
- Enlarged Heart
- Epilepsy
- Foreign Travel Residence
- General Use Questionnaire
- Glomerulonephritis
- Heart Attack Myocardial Infarction
- Heart Failure
- Heart Murmur
- Hemochromatosis
- Hepatitis
- Hypercoagulable Disorder
- Hyperglycemia
- Hypertension
- Irregular Heartbeat
- Kidney Function Tests
- Kidney Transplant
- Leukemia
- Liver Tests
- Lung Disease
- Lupus
- Lymphoma
- Mental Disorders
- Mitral Valve Disorder
- Multiple Sclerosis
- Neuromuscular Disorder
- Pacemaker
- Pancreatitis
- Panhypopituitarism
- Paralysis
- Parkinson’s Disease
- Personality Disorders
- Pheochromocytoma
- Polycystic Kidney Disease
- Polyp, Cyst, Tumor or Growth
- Prostate Benign
- Proteinuria
- PSA-Elevated
- Sarcoidosis
- Scleroderma
- Seizure Disorder
- Sickle Cell Anemia
- Sleep Apnea
- Spinal Cord Injury Plegic
- Stent
- Stroke, TIA
- T Wave Changes
- Thrombus
- Thyroid Disease
- Valvular Heart Surgery