Impaired Risk

Below is a list of impaired risk questionnaires. If you have a client with one or more of the following health conditions, you can get a quote online. Collect the asked for details from your prospect and complete the form found here. It will be submitted electronically and you will receive a response within 48 hours.


Do your clients have any of the following?
Heart Disease Diabetes Stroke Smoker
Sleep Apnea Depression Alcohol Abuse Substance Abuse
Driving Violations Other

Obtain as complete a medical profile as is possible. The more detailed the submitted information is the more accurate the quote will be.


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Insurance Associates
617A Cliff Street
Battle Creek, MI 49014
269.968.8510 · 800.783.7378
Fax: 269.968.8531
shanlian@jasnetworks.net

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