Serious Illness Protection Checkup

A major diagnosis like cancer, heart attack, or stroke can change everything overnight. This checkup helps you see how protected you are—and where gaps may exist—so you can focus on recovery, not bills.

First Name *

Last Name *

Date Of Birth

Phone *

Email *

State

Which types of coverage do you currently have?

If you were hospitalized or diagnosed with cancer, what would concern you most?

How comfortable are you with your current protection?

Comfortable Monthly Budget for Added Protection

Anything else I should know about your situation?

Best Time to Reach You

Consent to be contacted *

By checking this box and clicking “Submit My Serious Illness Checkup”, you agree that Chris A. Roth and/or our partner carriers may contact you at the phone number and email address provided (including by autodialed, prerecorded, or artificial voice calls and text/SMS messages) about critical illness insurance, life insurance, and related products. You understand that your consent is not a condition of purchase and that you may revoke consent at any time. Message and data rates may apply. Your information is confidential and will only be used to provide your personalized recommendations.

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