Schedule an Insurance Consultation | Dickerman Financial Group

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Who Needs Coverage?

Let's start with who you're looking to protect.

Who needs final expense coverage? *

Myself

A loved one

Both

Basic Information

Just a few details about the person who needs coverage.

What is your date of birth? (MUST BE 45+) *

What is your gender? *

Male

Female

Prefer not to say

Health Screening

We work with carriers that offer coverage even with health conditions.

Have you had any of the following in the past 5 years? Check that apply. *

Heart attack or heart surgery

Cancer

COPD or use of oxygen

Stroke or TIA

Kidney disease or dialysis

Dementia or Alzheimer’s

Diabetes with insulin

HIV/AIDS

None of the above

Health & Lifestyle

A couple more health and lifestyle questions to match you with the right plan.

Are you currently in a nursing home, hospital, or hospice? *

Yes

Have you used any tobacco or nicotine in the past 12 months? *

Yes

Coverage Goals

What kind of coverage are you looking for?

How much coverage are you looking for?

$5,000–$10,000

$10,000–$20,000

$20,000+

What monthly budget are you comfortable with? *

Under $50

$50–$75

$75–$100

Over $100

Timing

When would you like your plan to start?

How soon are you looking to get coverage? *

As soon as possible

Within 30 days

Just exploring options

Do you already have any life insurance? *

Yes, but I’m looking for better coverage

Yes, but not sure if it’s right for me

Contact Information

One last step — where should we send your quote?

Full Name

Phone *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. Text HELP to (XXX) XXX-XXXX for assistance. You can reply STOP to unsubscribe at any time.

Preferred Method of Contact *

Call

Text

Best Time to Contact You *

Morning

Afternoon

Evening

Wake Forest, NC

Location