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Lincoln Investment and Capital Analysts Form CRS
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Personal
Agricultural
Business
Financial
Life
Medicare
Health
Resources
FAQs
News
Contact
Locations
Contact Our Team
24/7 Claims
Join Our Team
Client Resources
Client Portal
24/7 Claims
Business Requests
Personal Review Surveys
Online Payments
Broker Check
About Us
Our Story
Our Mission
Our Team
Our Partners
Services
Personal
Agricultural
Business
Financial
Life
Medicare
Health
Resources
FAQs
News
Contact
Locations
Contact Our Team
24/7 Claims
Join Our Team
Client Resources
Client Portal
24/7 Claims
Business Requests
Personal Review Surveys
Online Payments
Broker Check
Review SurveyContact Information
Name Insured #1
Cell Number
Email
Occupation
Employer & City
Education Level
Name Insured #2
Cell Number
Email
Occupation
Employer & City
Education Level
List all children in the household, their date of birth, and sex.
Non Household Member Emergency Contact Name
Relationship
Non Household Member Emergency Contact Phone
Non Household Member Emergency Contact Email
Non Household Member Emergency Contact Address
HEALTH INSURANCE/MEDICARE - Do you currently not have health insurance through an employer, thinking about retirement, or needing to look into Medicare with turning or over age 65?
Yes
No
DENTAL & VISION - Most medical plans, including Original Medicare, do not cover dental and vision. Would you like to explore dental and vision insurance options?
Yes
No
CANCER COVERAGE - 1 in 2 men and 1 in 3 women in the U.S. will be diagnosed with cancer in their lifetime. Do you have a family history of cancer? Are you interested in discussing cancer benefit options?
Yes
No
HEART ATTACK & STROKE - Every 40 seconds, someone in the United States experiences a heart attack or stroke. Are you concerned about coverage for heart attack or stroke-related care and how it may affect your daily living cost? Would you like to learn more about insurance options for these conditions?
Yes
No
RECOVERY CARE - Have you or a family member ever used home health care or stayed in a nursing home? The average cost for nursing home care in the U.S. for a private room is $361 per day, assisted living is $194 per day and home health care is $33 per hour. Do you have a plan in place if you require assisted living or long-term care? Would you like to discuss options for nursing home, assisted living, or home health care coverage?
Yes
No
LIFE INSURANCE & FINAL EXPENSES - The average funeral with burial cost $8,280. Do you currently have life insurance to cover funeral expenses? Would you like to discuss funeral expense coverage options?
Yes
No
FINANCIAL PLANNING - Do you currently have a financial advisor? If not, would you like to be contacted about financial planning services?
Yes
No
BENEFICIARIES - After big life events such as changes in marital status or having children, it is important to review how your policies and investment portfolios are set up. Would you like an account manager to contact you to review your beneficiaries?
Yes
No
Additional Comments, Concerns, or Suggestions
Signature (Please type name for electronic signature)
Submit
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