About this template
Streamline your client underwriting process with this comprehensive Life Insurance Questionnaire template. Designed specifically for insurance agents, brokers, and financial advisors, this form collects essential applicant details, financial goals, medical history, lifestyle habits, and beneficiary designations in an organized manner. Instead of chasing clients for missing details or managing messy paperwork, agents can send out this structured questionnaire to gather everything needed for accurate risk assessment and policy quoting.
The template covers critical data points including personal identification, coverage amounts, employment details, height and weight, tobacco use, current medications, primary care physician information, and family medical background. By centralizing this information, you can accelerate underwriting turnaround times and provide a smoother, more professional onboarding experience for your clients. Transitioning your intake process to Doc2Form ensures you capture complete, accurate submissions ready for review.
Key features
- Collect comprehensive medical history and lifestyle data in one organized submission.
- Streamline beneficiary designations and coverage amount preferences.
- Standardize underwriting intake to reduce follow-up emails and missing details.
- Access responses instantly from any device for faster quote generation.
- Easily customize sections to fit specific term or whole life policy requirements.
Use cases
Independent insurance agents onboarding new life insurance prospects.
Financial planning firms conducting annual insurance needs assessments.
Brokerage teams collecting preliminary underwriting data before forma…
Brokerage teams collecting preliminary underwriting data before formal application submission.
What this form collects
- Primary Insured Full Name (Short answer)Enter your first, middle, and last name.
- Date of Birth (Date)Enter your date of birth (MM/DD/YYYY).
- Gender (Multiple choice)Select your gender as listed on official identification.
- Contact Information (Short answer)Provide your current phone number and email address.
- Home Address (Paragraph)Enter your full residential address, including street, city, state, and zip code.
- Marital Status (Dropdown)Select your current marital status.
- Physical Measurements (Short answer)Please enter your approximate height and weight.
- Tobacco Use Status (Multiple choice)Have you used tobacco or nicotine products in the past 12 months?
- Employment and Occupation (Paragraph)Enter your employer name, job title, and estimated annual income.
- Life Insurance Goals & Coverage Amount (Paragraph)What is your primary goal for this insurance, and what death benefit amount are you seeking?
- Primary Beneficiary Full Name (Short answer)Enter the full name and relationship of your primary beneficiary.
- Medical History & Medications (Paragraph)List any major medical conditions, surgeries, or regular medications you currently take. If none, type 'None'.
- Primary Care Physician (Short answer)Provide the name, clinic, and phone number of your primary doctor.
FAQ
How does Doc2Form help with insurance questionnaires?
Doc2Form allows you to instantly generate a clean, professional Google Form from this template, making it simple to collect and manage client data without complex setup.
Can I customize the questions on this life insurance form?
Yes! Once the template is in your Google Forms account, you can freely add, remove, or edit any questions to match your agency's specific underwriting requirements.
Is this template suitable for both term and whole life insurance?
Absolutely. The questionnaire covers core personal, medical, and financial metrics applicable to virtually any type of life insurance product.
How do clients complete and submit the questionnaire?
You simply share the Google Form link with your client via email or text. They can complete it securely from their smartphone, tablet, or computer.
Where are the submitted questionnaire responses stored?
All responses are automatically saved in a secure Google Sheets spreadsheet linked directly to your form, allowing for easy tracking and review.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.