Insurance Needs Analysis Questionnaire

A short set of qualifying questions covers residency, dependants, existing cover, health, and outstanding debts. The answers show which protection products deserve a closer look before an adviser calls. Ideal for brokers triaging enquiries that arrive from a website.

Use this template

Already have an account? Log in

Are you a UK resident?

Yes No

What is your gender?

Female Male Prefer not to say

Do you have children?

Yes No

Do you already have a life insurance policy in place?

Yes No Not sure

Is your policy written in trust?

Yes No Not sure

Have you had your existing policy for more than 4 years?

Yes No Not sure

What is your current employment status?

Employed Self-employed Retired Not working Student

Are you a homeowner?

Yes, with a mortgage Yes, owned outright No, I rent

Which age range applies to you?

Under 30 30 to 39 40 to 49 50 to 59 60 or over

Do you have any health conditions?

Yes No Prefer not to say

Do you have any credit cards, loans, a mortgage, or car finance?

Yes No

Which products would you like reviewed or advised on?

Life insurance Critical illness cover Income protection Over 50s cover Mortgage protection Private medical insurance

Do you already have a free consultation booked?

Yes No

Full name

Nombre

Apellido

Phone number

Postcode

What is the best time to contact you?

Related templates

Histamine Intolerance Quiz Healthcare HMO Dependent Enrollment - Field Office I Insurance Home Assessment Form Healthcare Home care needs assessment Healthcare

Browse all assessments templates →

Powerful online forms — builder, logic, products, and teams — at a price that makes sense.

Product

Features
Pricing
Compare
Alternatives
Templates
Claude
API
GitHub

Company

Press room
Brand kit
Contact

Legal

Terms of service
Privacy policy
Cookie policy

Rejoining the server...

Rejoin failed... trying again in seconds.

Failed to rejoin.
Please retry or reload the page.

The session has been paused by the server.

Failed to resume the session.
Please retry or reload the page.