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For: Tom Agent
Type: LTC |
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Contact Information |
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Name: |
Jim Customer |
Email: |
jimc@emailforyou.com |
Address: |
123 Sample Lane |
Daytime Ph: |
(123) 234-0934 |
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Anywhere, AL 90012 |
Evening Ph: |
(123) 234-4523 |
Contact Via: |
Phone |
Time of Day: |
Afternoon |
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Insurance Information |
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Currently Insured: |
No |
Company: |
N/A |
Currently Paying: |
N/A |
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Amount Needed: |
$500,000 |
Length: |
10 years |
Reason for use: |
Mortgage Protection |
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In the last 12 months, this person has: |
Been
confined to a nursing home, Received Home health care
services |
Health Information |
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Date of Birth: |
March 8, 1962 |
Tobacco Use: |
NONE |
Current Health Problems: |
I have High Blood Pressure, but am taking
medication. |
Medications: |
ProAmatine |
Family Health History: |
Paternal Grandmother died at age 52 of heart
attack |
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This person has
been diagnosed with the following in the last 10 years: |
High Blood Pressure, Cholesterol |
Details on above diagnoses: |
I have lowered my choleserol to a normal
level and take Proamatine for the Blood Pressure. |
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Addtional Comments: |
If possible, call me at work from 2-4pm. |
