How Do I Get Started with
Long Term Care?

Fill In The Simple Questionaire
To Get Started.

We’ve Made it Simple & Easy

CLAREN Long Term Care recognizes that not every family requiring long term care is the same, so we created a simple and confidential questionnaire to help guide us in the right direction when it comes to your individual needs.

The questionnaire is simple and easy and only takes a few minutes to complete.  In some cases, long term care may not be an option; our questionnaire will let us know if long term care is suited for your needs, and if so what the best plan may be.

**Your information is confidential, and will only be viewed by our office staff to determine the best care plan for you and your family.**
Qualification Questionnaire
  • General Information
  • Care Plan & Overall Health
  • Detailed Health Points
  • Medications
  • Your Needs & Submit
This is where we will send important information about your application, including decision notices.
Best Time for Us to Call You *
Address
City
State/Province
Zip/Postal

Height & Weight

This field is automatically calculated and does not require your input.

“If I would have known how easy this process could be, I would have done this for my family years ago.

Josh G. Tampa, FL

“1 in 4 adults who are 45 years old or older are financially unprepared for long-term care expenses.” – AARP

AARP

“This was so much quicker and easier than I ever thought possible, and I ended up with a policy that provides me with better coverage than I had before, at a lower price.” – W.F.S

W.F.S

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