If you would like our assistance with any of your more challenging cases, please complete one of the following questionnaires.
Download our HIPPA Authorization Form
Diagnoses
Alcohol Abuse
Alzheimer’s Disease
Angina Pectoris
Angioplasty
Aortic Valve Disorder
Arrythmia
Asthma
Bladder Cancer
Bowel Dissease
Breast Cancer
Cancer
Cardiac Catheterization
Cardiovascular
Cerebral Vascular Accident (Stroke)
Cervical Cancer
Colitis
Colerectal Cancer
Coronary Artery Bypass
Coronary Artery Disease
Crohn’s Disease
Dementia
Depression-Anxiety
Diabetes
Drug Abuse
Epilepsy
Fibromyalgia
Heart Attack
Heart Bypass
Heart Murmur
Hemophilia
Hepatitis
Hypertension
Inflammatory Bowel Disease
Kidney Disease
Leukemia
Lupus
Lyme Disease
Mental Illness
Mitral Valve Prolapse
Multiple Sclerosis
Parkinson’s Disease
Peripheral Vascular Disease
Prostate Cancer
Pulmonary Disease
Rheumatoid Arthritis
Skin Cancer
Sleep-Apnea-Questionnaire
Stroke
TIA (Mini-Stroke)
Testicular Cancer
Other Medical Factors
Liver Enzymes
Medications
Over Age 70
Pacemaker
Hazardous Activities:
Aviation
Foreign Travel
Hazardous Activities
Racing
Scuba and Skin Diving
Sky Diving, Mountain Climbing,
Parachuting or Ballooning
Other:
Click here to submit a Substandard
Case Preliminary Inquiry »
Do You Have a Problem Case? Would You Like to Obtain the Best Possible Offer?
Click here to submit a Substandard Case Preliminary Inquiry »