Tic Travel Insurance Medical Questionnaire

The tic travel insurance medical questionnaire helps the organization to identify the specific requirements of each of their clients. TIC is one of the leading players in the Canadian travel health insurance industry and offers travel medical insurance plans for Canadians, International tourists, students, and expatriates among others. The tic travel insurance medical questionnaire helps the company to customize their medical travel insurance plans and offer the best deal to their customers.

Sample Tic Travel Insurance Medical Questionnaire:

Name of the Participant: _____________________________

Insurance Number:_________________________________ (Those with existing insurance policies)

Citizenship: _______________ (Other than Canada)

Purpose of visit: ____________________________ (For International Tourists, visitors, and students)

Email: _____________________________

Phone Number: ____________________________

Date of Birth: ___________ Gender: _____ (M/F)

  • Have you ever been issued a travel medical insurance policy by TIC?

a)      Yes

b)      No

c)      Don’t Remember

  • How often do you travel to Canada or outside Canada?

a)      Very Often

b)      Often

c)      Sometimes

d)     Not very often

e)      Never

f)       This is my first time

  • Have you been diagnosed with any of the following medical conditions?

a)      Congestive heart failure

b)      Acquired Immune Deficiency Syndrome (AIDS)

c)      Human Immunodeficiency Virus (HIV)

d)     Alzheimer’s disease

e)      Terminal illness

f)       Pancreatic or Liver cancer

g)      Undergone major organ transplant

h)      Kidney dialysis treatment

i)        Terminal illness

  • Have you been diagnosed with or treated or investigated in the last 24 months for any of the following conditions?

a)      Cerebrovascular condition            Yes | No

b)      Cancer                                           Yes | No

c)      Cardiovascular condition              Yes | No

d)     Emphysema or COPD                  Yes | No

e)      Diabetes                                        Yes | No

  • Are you looking for coverage for all your pre-existing medical conditions whether they are listed here or not?

a)      Yes

b)      No

c)      Not Sure

Category: Travel Questionnaire

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