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Rapid Needs Analysis

Want to accelerate the process of getting insurance? This form is the right place to start. Just fill it out as accurately as you can and the information you provide will help jump-start the process! We may even have a quote ready by the time you call.

Gender assigned at birth
Male
Female
Marital Status?
Single
Married
Number of dependents under 18
none
1-2
3+
Are you a smoker?
No
Yes
Do you have any significant medical conditions? (diabetes, heart problems, high blood pressure, serious mental health issue requiring treatment or similar)
No
Yes
Total household income (before income tax)
Less than $60K/year
$ 60-100K/year
$100-150K/year
$150-225K/year
more than $225K/year
Monthly discretionary income (available for insurance & savings)
less than $100/mo
$100-250/mo
$250-500/mo
more than $500/mo
Employment level?
Unemployed
Part-time
Full-time
Full-time self employed
Retired
Existing life insurance amount?
none
less than $100K
between $100K & $1M
more than $1M
Which best describes your insurance need (select one)?
just curious
family protection (mortgage, child or spousal care)
investment planning
additional health/dental
critical illness and/or disability
retirement planning
estate protection
business protection
bequeathment
payout annuity
Do you own a home?
Yes
No/rent
Do you own any additional property (cottage, income unit ...)?
Yes
No
Balance owing on existing mortgages?
none
less than $100K
between $100K & $500K
between $500K & $1M
more than $1M
Which of the following financial statements describes you best?
I prefer to be conservative and don't trust the stock market
I prefer to be conservative but realize there is a risk of being too conservative
I don't mind taking some risk as long as it's balanced
Without taking risks there aren't rewards, but I think it's prudent to include some lower risk options in a portfolio
My primary concern is growth and I'm willing to accept the accompanying risks
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