Diversified Insurance Brokers specializes in the impaired risk life insurance needs of your customers. Below are underwriting questionnaire forms.  Simply download the one that best applies to your client, complete, and fax back to us for review.

The more information you can give us the better chance we have of finding the right product for your client.

Fillable Condition Specific UW Questionnaires:

Click on a specific condition below for fillable form.

Alcohol and Substance Abuse Form

Arthritis Form

Asthma Form

Aviation Form

Cancer Bladder Form

Cancer Breast Form

Cancer Cervix Form

Cancer Colorectal Form

Cancer Form

Cancer Hodgkins and Lymphoma Form

Cancer Leukemia Form

Cancer Ovarian Form

Cancer Prostate Form

Cancer Skin Form

Cancer Testicular Form

Cholesterol Form

Colitis-Crohns Form

Depression Form

Diabetic Form

Epilepsy Form

Foreign Travel-Residency Form

General Form

Heart Attack Form

Heart Bundle Branch Block Form

Heart Cardiomyopathy Form

Heart Disease Form

Heart Irregular Heart Beat Form

Hepatitis Form

HIV Form

Kidney General Form

Liver Enzymes Form

Lupus Form

Multiple Sclerosis Form

Parkinsons Form

Prostate Elevation Form

Pulmonary Disease Form

Sarcoidosis Form

Sleep Apnea Form

Stroke Form