Your coverage should grow with you... not against you.

Over time, life changes... and so do your needs. This quick review will help you confirm if your current policy is still the best fit for your final wishes, health, and family’s protection.

By answering these questions, you’ll give us the insight we need to uncover opportunities for stronger benefits, better pricing, or improved peace of mind... without losing what’s already working for you.

Basic Details

First Name *

Last Name *

Gender *

Male

Female

Phone *

Leave Blank If No Email Address

State *

Policy Details

How Many Policies Do You Have? *

4 or More

Which Company Is Your Current Policy/Policies With? *

(If More Than 1, List All Companies)

How Long Have You Had Your Policy/Policies? *

What Is Your Monthly Premium Amount? *

(If More Than 1 Policy, Put TOTAL PREMIUM AMOUNT FOR ALL POLICIES)

Premium Payment Method: *

Bank account draft (checking/savings)

Debit card draft

Prepaid or other

Do You Have A Fixed Monthly Premium/Premiums? *

Yes. Same Price Every Month

No. It Increases Over Time

Not Sure

What Is Your Coverage Amount? *

(If More Than 1 Policy, Put TOTAL COVERAGE AMOUNT FOR ALL POLICIES)

Is There A Waiting Period On Your Coverage? *

No Waiting Period

2 Years

3 Years

Not Sure

Policy Review Goals

Do You Feel Your Current Plan/Plans Meet Your Needs? *

Yes

What’s Your Biggest Concern About Your Current Policy/Policies? *

(No "Right" or "Wrong" answers. Speak your mind)

Are You Looking For Lower Rates, More Coverage...? *(Select All That Apply)

Terms & Conditions

By submitting this form, I agree to receive phone calls and text messages from FHA Life Assistance Group, which may be sent using automated, pre-recorded, or AI-assisted technology for marketing or service purposes. I understand that I may opt out at any time and that calls may be recorded for quality assurance.