Louisiana Life Insurance.com

    1-888-456-1858 / 504-456-1858

Where you can call & consult with an expert for ten minutes, toll free !  or   Consult an Expert!

Please answer with complete details the questions below:

Uninsurable ?.......Very Unlikely.........Take the 10 second Test !

EPILEPSY/SEIZURES 

 

Definition: Abnormal nerve cell activity in tile brain. Can be brief alternations of consciousness, or motor and sensory dysfunction may occur Could also have episodic attacks of inappropriate behavior

 

 

A. Type of attack? (in: grand mal, petite mal)

B. Number of attacks in the last 12 months? If any, give dates of each.

C.
Does client have current valid driver's license and are they able to drive a car? If no, explain.   

D. Answer ALL questions listed under
     #1 General Risk Profile 

 

 

GASTROINTESTINAL PROBLEMS
 
Ulcerative Colitis, Crohn's Disease


Definition:
Ulcers are an irritation of the wall of the stomach (peptic), the esophagus (esophageal), or the bowel (duodenal). Ulcerative colitis is an inflammation of the mucosal layer of the large bowel wall. Crohn's Disease is the inflammation involving the entire bowel wail which can involve any portion of the Gastrointestinal tract

 

A. Date, duration and severity of last attack?

B. Type of treatment? Was surgery performed? If so, give dates and details.

C. Did proposed insured ever have any bleeding? If so, give date(s)

D. Answer ALL questions listed under
     #1 General Risk Profile Risk Profile 

 

                     Request a quote                                               Fax your medical reports to 504-885-4640

   Consult with an expert for ten minutes,  free.... call  1 888 456 1858