Allianz Visitors to Canada Medical Questionnaire Detailed
How to complete this form
• Complete one form for each person applying for insurance.
• Answer all questions on the form.
• If you’re unsure about your answers, please talk to your physician first.
• Applicant, legal guardian or power of attorney must sign and date the form.
• If you have any questions about this form, you can reach us toll-free at: 1-888-298-8151.
• If your application is missing information or isn’t signed and dated, we’ll have to follow up with you or your agent/broker and it will take longer to process your application. For the complete terms, conditions, limitations and exclusions please refer to the policy.
Your form entry has been saved and a unique link has been created which you can access to resume this form.
Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.
Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.
Office Hours: 8:30-4:30 MT
Simpson Group Insurance Services
99 Evergreen Terrace SW
Calgary, AB, T2Y 2R7 Canada
Proud member of the Travel Health Insurance Association of Canada (THIA)
Site by Daniel
Office Hours: 8:30-4:30 MT
Simpson Group Insurance Services
99 Evergreen Terrace SW
Calgary, AB, T2Y 2R7 Canada
Proud member of the Travel Health Insurance Association of Canada (THIA)
Site by Daniel