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Needs Analysis Form


Complete and submit the following information to help us confirm the best health benefits approach for your situation.

Health Benefits - What's Important?

Type of Coverage Required:

Please identify which of the following health benefits are important to you...


Medical Practitioners: (for all that apply, provide average # of visits per year and cost per year)

- Acupuncture?

- Chiropractor?

- Massage Therapy?

- Naturopath?

- Physiotherapist?

- Podiatrist?

- Osteopath?

- Psychologist?

- Speech Therapist?

Vision Care? (includes prescription glasses, contact lenses, and laser eye surgery)
Emergency Medical Travel Insurance?

Thanks for submitting!

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