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McDonald Healthcare Solutions
Client Health Coverage Questionnaire

I hope this finds you blessed.  

Completing this form will be the hardest part of the entire process of shopping for health coverage.

So, here's what I do in a nutshell:  Technically there are so many plans available to you and with all of the drastic industry changes, it can be hard to make an educated decision on what's best for you and/or your family.  I'm going to take the information you provide (listed below) and impartially shop all of the plans available to you.  Please send this information for everyone needing coverage.  Please make sure all information is filled out accurately and completely.

Once I have this form from you, I will shop the plans available to you and anything else you may qualify for or be eligible to receive--including any discounts.  I will eliminate all of the plans your doctor doesn't accept and that are out of your projected budgets.  I'll have them all pulled and show you the best options and highlight their benefits and features, and answer all of your questions as we go.  Once we find the plan you like most, I'll help you enroll.  It's that easy :)!

As I mentioned in the email, please return to this form after scheduling your appointment and click submit so I can be prepared for our call and avoid any potential delays in getting coverage started.

Please answer the questions for everyone who needs coverage (please complete one form per person in the household, including children).
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Email *
Full Name of everyone needing coverage *
Best phone to reach you *
Full Address With City, State, and ZIP Code *
Date of Birth (MM/DD/YYYY format, please) of everyone needing coverage *
Height and Weight of everyone needing coverage *
Yearly Gross Household Income *
Does anyone use Tobacco?  If yes, who? *
Does anyone have high blood pressure?  If yes, who? *
Does anyone have diabetes?  If yes, who? *
Pregnant or expecting a child (applies to men and women) *
Pre-existing health issues (this includes anything that requires--or did require--regular doctor visits, regular/daily medication, or could warrant a future surgery).  Please list them all here. *
Any scheduled or recommended surgeries
DUI in the last 24 months? If yes, who? *
Current medications (names and dosages are needed). *
Last 12 month health history (other than wellness checkups) *
Name and phone numbers of doctors *
Employer *
Job Title *
Current coverage, deductible, premium? *
Needed Start date *
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Please CLICK HERE to schedule a time to discuss covrage options.

Once you've done this, please come back to this page, answer the reamining quesitons, and click submit at the bottom :)
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Please provide any additional information you'd like considered while looking for a health plan or discussed on our call.
Because the lawyers make me put this here. . . By completing this form and clicking submit below, you're giving Lloyd McDonald, McDonald Healthcare Solutions, and any necessary contracted enrollment agents permission to discuss health coverage options with you, help with weighing the pros and cons of each option, and, upon selecting an option that best suits your needs, assist you in the completion of the application/enrollment process.  This concent can be withdrawn at any time by sending an email to lloyd.mcdonaldhealthcaresolutions@gmail.com. *
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