Questionnaires for medical impairments/avocations
Kristie Carlsen is MVP’s Director of Underwriting. To help her more accurately review your case, please complete the appropriate form below.
You may also email your underwriting questions to mvpinfo@mvp4me.com or fax to your local MVP office.
Quote the right class the first time* – Complete this General Info Underwriting Criteria Questionnaire or a more comprehensive questionnaire: Preliminary Medical History Form.
Scroll down for specific impairment underwriting information.
For specific impairments, a number of online forms are available here:
Click here for online questionnaire builder
Or, complete and return one of the PDF versions below:
- Alcohol
- Angioplasty
- Anxiety disorders
- Arthritis
- Atrial fibrillation
- Aviation
- Avocations
- Build
- Bundle branch block
- Cancer
- Cancer bladder
- Cancer breastView a case study
- Cancer cervical
- Cancer ovarian
- Cancer prostateView a case study
- 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
- Diabetes mellitus
- Down syndrome/Intellectual disability
- Underwriting special needs
- 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
- Marijuana: Pru Rx for Success
- 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
- Ulcerative colitis
- Valvular heart surgery
- Financial questionnaires
- Body mass index (BMI) calculator
Note: The calculation is only for quoting purposes. The final rate class offered by a carrier will be impacted by factors and conditions determined after a review of the life insurance application. - Banner’s intouch underwriting microsite
*Results may vary and are not guaranteed. The underwriting criteria questionnaire is intended as a tool to guide advisors to more realistic underwriting expectations and lead the application process.