Travel Insurance- Quote Request

Traveler 2*

First nameLast name

Date of birth*

JourMoisAnnée

Do the travellers stay at the same address?*

YesNo, enter the address

Have you used tobacco/vaping products in the last 24 months?*

YesNo

Please select one or more options that apply to you...*

Do you take medication on a regular basis?Do you have any pre-existing health problems?Have you been hospitalized in the last 12 months?In the 6 months prior to the effective date, have you had two or more falls that were reported to a doctor?On your departure date, you will have a medical condition that will not be stable and under control?Do you need assistance with daily life activities (personal hygiene, feeding, dressing)?Your doctor has advised you not to travelNone of these choicesOther

High blood pressure*

YesNo