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What is your date of birth?

Month

Date

Year

Why are we asking about your age?

Health insurance is valuable at any stage of life, offering peace of mind and security for your loved ones.

Please tell us a little bit about about you.

Gender

Height (Feet)

(Inches)

Weight (lbs.)

State

Zip Code

Why are we asking about these particular personal attributes?

Gender can influence health and help us find health insurance policies better aligned with your needs. Your height and weight allows us to have a more complete health profile of you and can significantly impact your needs.

Can you share your health history ?

How would you describe your overall health?

Why are we asking about your medical history?

Your medical history helps us match you with quotes that consider your health history. We work with multiple insurance carriers that can help find affordable rates, even for those with health concerns.

What are your current risk factors?

Do you currently smoke cigarettes or e-cigarettes?

Have you had more than 3 driving violations in the past 3 years?

Do you engage in any high risk activities such as piloting aircraft, bungee jumping, mountain & rock climbing, hang gliding, scuba diving, skydiving

How do risk factors effect my rates?

Your driving record as well as other lifestyle choices help assess risk and find coverage suitable for you. We can help you find the right coverage, regardless of your history.

Can you tell us about your current financial situation?

What is your current income level?

Why are we asking about your income?

This is the total amount you earn per year based on wages and salary before taxes. Bonuses, commissions, freelance earnings, or other variable pay should be factored in to reflect actual annual income. However, this should not include any income from investments or retirement accounts..

Can you share your insurance status?

Are you currently insured?

Why are we asking about your insurance status?

Whether you are looking for individual coverage or coverage for a family will impact the monthly premiums of deductibles.

What type of insurance are you looking for?

Who is the coverage for?

Individual Family

Why are we asking about insurance types?

The type of health insurance you’re interested in helps us match you with the best available options from the insurance carriers we partner with. Family coverage will usually have higher premiums and deductibles but may save per individual.

Who are we preparing this quote for?

First Name

Last Name

Phone

Consent Agreement

I agree to receive text messages from TrueChoice Coverage regarding quotes, policy updates, and account-related information at the phone number provided. Message frequency varies. Message & data rates may apply. Reply STOP to opt out or HELP for help. Consent is not a condition of purchase. View our Terms and Conditions and Privacy Policy

Why are we asking for contact information?

Your name and email allow us to send you information about your quote. This email will also be used for your policy, should you decide to move forward.

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