Health Insurance Questionnaire Template

A Health insurance questionnaire template is a ready too use document for framing a questionnaire to assess the physical condition of an individual for insurance coverage. The template includes the personal and medical history of an individual.

“You can Download the Free Health Insurance Questionnaire Template form, customize it according to your needs and Print. Health Insurance Questionnaire Template is either in MS Word, Excel or in PDF.”

Sample Health Insurance Questionnaire Template

Health Insurance Questionnaire Template

Download Health Insurance Questionnaire Template

Name_______

Age_____

Sex_______

Contact Details____________

(This section asks for personal and contact details of person.)

Blood group________

Weight________

Height_______

(Here the health information will appear.)

Questionnaire

(This is the main section of template for questions.)

1. Name the type of insurance cover you need?

A. Option 1.

B. Option 2.

C. Option 3.

D. Option 4.

2. Whom the claim should be sent to?

A. Option 1.

B. Option 2.

C. Option 3.

D. Option 4.

3. Do you have any chronic dieses problem, if yes then name it?

A. Option 1.

B. Option 2.

C. Option 3.

D. Option 4.

4. Have you undergone any medical surgery in the last 1 year, if yes then please provide details? ____________________

Category: Questionnaire Templates

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