Downloadable Forms & Questionnaires

Download these helpful forms and questionnaires to help us better understand your needs and provide you with the most appropriate coverage options. Take your time to complete them thoroughly—the more information you provide, the better I can serve your needs.

Long term care questionnaire

Long Term Care Questionnaire

This comprehensive questionnaire helps us understand your long-term care insurance needs, health history, and coverage preferences.

What's included:

  • Personal and family health history
  • Current coverage information
  • Coverage preference questions
  • Financial planning considerations
Trial application forms

Trial Application

Complete this trial application to help us provide you with accurate quotes and coverage options tailored to your specific situation.

What's included:

  • Basic personal information
  • Coverage amount preferences
  • Health screening questions
  • Beneficiary information

How to Use These Forms

1. Download the Form

Click the download button above to save the PDF to your computer. You can then print it or fill it out digitally if your PDF reader supports form filling.

2. Complete Thoroughly

Take your time to answer all questions as completely and accurately as possible. The more information you provide, the better I can serve your needs.

3. Submit Your Completed Form

You can submit your completed form by:

4. Follow Up

After reviewing your questionnaire or application, I'll contact you to discuss your options, answer questions, and provide personalized recommendations.

Additional Resources

Here are some helpful external resources for insurance and financial planning. These government websites and official sources provide valuable information to help you make informed decisions.

Covered California

Official California health insurance marketplace.

Medicare.gov

Official Medicare website with plan information and resources.

Social Security

Information about Social Security benefits and retirement planning.

Tax Forms

Access tax forms and resources for your financial planning needs.

Coaches

Find professional coaches for lifestyle and personal development.

Need Help?

If you have questions about any of these forms or need assistance completing them, don't hesitate to reach out. I'm here to help guide you through the process and ensure you get the coverage that's right for you.

Call or Text

(805) 528-4358

Office

2106 9th Street
Los Osos, CA 93402

Phone

(805) 528-4358

Fax: (805) 528-8140

Office

2106 9th Street
Los Osos, CA 93402
CA License #0E26264
Monday-Thursday: 9:00 AM - 3:00 PM