Physician Disability Comparison Request

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Lets start with the simple stuff! Should only take 1-2 minutes to complete
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Sponsoring InstitutionYour institution is tied to unique GME Training Discounts
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Sponsoring Institution* This field is required.Your institution is tied to unique GME Training Discounts
Please Select
Please Select
Baylor Scott & White
Dartmouth - Hitchcock
Emory University
Rush University Medical Center
University of California - San Francisco (UCSF)
University of Florida - Gainesville
University of Miami
University of South Florida (USF)
University of Pittsburgh Medical Center - UPMC
Vanderbilt University
Other
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Name* This field is required.
First Name
Last Name
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Age* This field is required.
Current Age
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Personal Email* This field is required.if you put your hospital email - our comparison summary will likely be sent to spam bc we attach the side by side carrier comparison pdf. We would prefer to use personal email, but if you use your hospital email, please be on the lookout for our email.
example@example.com
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Are you currently in training?* This field is required.Residency / Fellowship
YESNO
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Do you finish training this summer?
YESNO
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Tell us about your training program
Current Specialty
Yr. you expect to finish training
additional notes - ex: if you plan to do a fellowship, are you a Non-US Citizen, Military Residency
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Tell us about your current training program and future employer (if known)* This field is required.
Current Specialty
Current Training Program Name (Hospital/ University)
Future Employer (if known)
Future Start Date (if known)
Future Income (if known)
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Tell us about your position* This field is required.
Specialty
Employer
Income
Do you have any other Long - Term Disability coverage in place?
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Do you currently have Student Loans?Could be Federal or Private
YESNO
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Approximate Student Loan Amount
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Are you 100% confident in your current financial plan? If not, we have a team of specialists ready to help. Mark any that would help you sleep better at night and we will connect you with a specialist.* This field is required.
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Would you like a text notification once we send the comparison summary? We will only send confirmation that it has been sent.* This field is required.we know you get a lot of emails and sometimes our physicians have a hard time knowing when we sent them their comparison summary. With the comparison pdf attached, the emails also sometimes go to spam.
YESNO
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Want a Life Insurance Quote?* This field is required.We can knock out both at the same time super easily
Yes, just for Myself
Yes, for My Spouse and I
Not at this time
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Spouse Information
First Name
Last Name
Age
Gender
Email
Please Select
Please Select
Yes
No
Medical school
Is your spouse a physician?
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Phone Number - We will ONLY use this to send a text confirmation that the comparison summary has been sent.* This field is required.Many of our physicians mentioned that they never received our comparison summary or it gets lost in your ever growing inbox. We simply send you 1 text to let you know that we sent the quotes so that you can be on the lookout for it.
Area Code
Phone Number
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How did you hear about Twin Oak?* This field is required.
Chief Resident
Program Coordinator
A Colleague
Webinar
Email
Web Search
LinkedIn
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Please let us know who so we can thank them!
First Name
Last Name
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Last Step! - Any major health concerns or major medical diagnosis?* This field is required.This is kind of like giving us your symptoms to get a more accurate diagnosis of which carrier is best for you. If yes, we just have a few more questions to give us better background info.
YESNO
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