Sample Alcohol Questionnaire

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					                      Sample Alcohol Questionnaire
If you are applying for life insurance with a history of alcohol abuse, you will be required
to provide detailed information regarding your alcohol use history. Your answers to the
questions below will determine which insurance company will offer you the most
competitive rate for life insurance. Each company has their own specific alcohol
questionnaire and their own guidelines for assessing an individual’s risk level. MEG
Financial can help you identify your top alternatives. Call MEG today at (877) 583-3955 or
request a custom life insurance quote.

1. What are the complete details of your alcohol usage history?
Consumption history, frequency, type and amounts, Date of last use

2. Have you ever been treated for alcohol abuse?
When? Where Treated? Impatient or Outpatient? Duration and Treatment

3. Have you ever used drugs or received treatment for drug abuse?
When? Where Treated? Impatient or Outpatient? Duration and Treatment

4. Are you a member of Alcoholics Anonymous (AA)?
When did you join? Attend regularly?

5. Have you ever been arrested for DUI, DWI or reckless or careless
Need complete details of any driving offenses.

6. Do you have any medical problems including high blood pressure,
diabetes, heart or circulatory issues or liver disease including elevated
liver enzymes?
Need complete details including date of diagnosis, duration, treatment and attending physician.

7. What medications are you currently taking?
Provide complete list including names and dosages.

8. Have you had family or employment problems as a result of you alcohol
As discussed in getting a competitive life insurance rate with a history or alcohol use, a
detailed cover letter describing family, employment and lifestyle issues can go a long way in
helping paint a positive picture to the insurance company.

A past history of alcohol abuse does not make you uninsurable!
If you have had alcohol related problems, the key to applying for and securing a fairly
priced life insurance policy is to know which company will treat you the most favorably
based on your answers to the questions above. An experienced independent insurance
agent is crucial to helping locate your best policy option. At MEG Financial, we have
helped many individuals with histories of alcohol problems locate and obtain affordable
life insurance. Call MEG now at (877) 583-3955 for personalized service.

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