587-998-8587 info@insurecalgary.com

Health Insurance

Personal Health Insurance is a great way to protect your income and savings from unexpected and insufficient health care costs. Covering visits to the optometrist, dental care, physiotherapy to massage therapy. If you are retired, need self employed health insurance, own a small business or are a contract worker, this is a great option for you!

Critical Illness | Disability | Group Benefits | Personal Health | Pet

Health Application

  • Contact Information
  • Health/Doctor Information
  • Insurance Information

Contact Information

First Name

Last Name

Email Address

Phone Number


Postal Code

Date of Birth

Health/Doctor Information

Do you have a family doctor?

If yes, enter your doctor's name.

Are you a smoker?



Are you currently taking any medications?

If yes, please list your medications.

Insurance Information

Do you currently have health insurance?

If yes, how much coverage do you have?

If yes, please list your current insurance company

Our Insurance Partners

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