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Impaired Risk

Special Risk Evaluation Questionaire for Life Insurance

This is one easy to use Questionnaire that allows you to meet all of your Special Risk Needs. This unique evaluation questionnaire will tell you exactly what to ask your client about almost any malady. Your client will be impressed with your professional approach.

Methods to use these forms:

1. Special Risk Forms - Click on the Special Risk links below, type in the necessary information, Save to your local drive, Email or Fax the completed form. 

Alcohol/Drugs Angioplasty Arrhythmia
Coronary By Pass   Colitis
Chron's disease Coronary artery disease Depression
Diabetes Epilepsy Heart attack
Systemic Lupus Anxiety Disorders Heart murmur
Hepatitis Atrial Fibrilation| Kidney Transplant
Leukemia Mental Disorders Mental-NervousDisorder
Morals Multiple Sclerosis Paralysis
Parkinson's disease Bundle Branch Block Sleep Apnea
Stroke COPD Pulmonary Disease Cushing Syndrome
Glomerulonephritis Hemochromatosis Mitral Valve prolapse
Pancreatitis Polycystic Kidney Disease Scuba Diving
Sky Diving Racing Hypertension
Liver Functions Foreign Nationals  

2. Special Risk Cancer Forms



Download All Special Risk procedures
Step 1 - Click Here to download All Special Risk Forms to your computer

Step 2 - The files will be stored in the C:\Special Risk folder

Step 3 - Email or Fax the files to your client.

Step 4 - Fax or Email the completed form to QuickQuote@WalliserIns.com

Send the files Click on Download button

Step all the forms to your hard disk by clicking "download all Special Risk Forms". The forms will be saved to your local C: drive in folder C:/Walliser. They will be available to fill out if you don't have Internet access. You can then Email or Fax the completed forms. We can generally get a tentative quote for you within 24 hours, or less.

Please let me know what you think of this site-WebMaster: JeffHutch@Excel-Networksl.com

Contact Walliser Associates Insurance Agency at (831) 476-4384