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Medical questionnaire

As part of our service to help provide the most suitable recommendations to you, we aim to match the best products to your personal circumstances. Please complete the following questions and elaborate on the dates, symptoms and results in as much details as possible where appropriate.


Your personal information is treated with the utmost importance and this form will not be shared with anyone. It will be used solely for the purpose of research in order to find the right cover for you.

Because we care, we need to tell you that...

Your home may be repossessed if you do not keep up repayments on your mortgage.


There may be a fee for mortgage advice. The actual amount you pay will depend upon your circumstances.


The fee is up to 1%, but a typical fee is 0.3% of the amount borrowed.

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