Main Content

Form Code Form Name
D-0061 Adult - Short Question Set
D-0060 Adult - Full Question Set
D-0077 Air Activity Questionnaire
D-0110 Alcohol Drug Usage Questionnaire
  Authorization to disclose personal information to Advisor(s)
D-0018 Authorization To Release Information
D-0094 Aviation Questionnaire
D-0111 Back Pain Questionnaire
D-0049 Business Financial Questionnaire
D-0063 Children’s Life/Critical Illness Rider Question Set
  Covid-19 (Coronavirus) Exposure Questionnaire
D-0101A Diabetes Questionnaire
D-0093 Driving Questionnaire
INS-1019 Empire Life Vitals Form
D-0058 Exam by M.D.
D-0075 Foreign Travel Residence Questionnaire
  Form Ministry Of Health
D-0105 Gastrointestinal Questionnaire
D-0118 Gynaecological Disorder Questionnaire
D-0015 Hazardous Sports Questionnaire
D-0121 Heart Questionnaire
D-0076 Mature Age Questionnaire
D-0014 Military Status Questionnaire
D-0107 Motor Sports Questionnaire
  Motor Vehicle Report Authorization BC
  Motor Vehicle Report Authorization Manitoba
  Motor Vehicle Report Authorization QC
D-0019 Mountaineering Questionnaire
D-0119 Neurological Disorder Questionnaire
D-0079 Nicotine Usage Questionnaire
C-0026 Overseas Critical Illness Questionnaire
D-0057 Paramedical
D-0057A Paramedical Additional Information Supplement
D-0050 Personal Financial Questionnaire
D-0078 Power Boat Racing Questionnaire
D-0122 Psychological Questionnaire
  Quebec Driving Record Disclosure
D-0116 Respiratory Questionnaire
D-0112 Scuba Diving Questionnaire
D-0109 Seizures Questionnaire
D-0016 Skiing/Boarding Questionnaire
D-0056 Supplemental Health Information
D-0056A Supplemental Health Information - Medical History Continuation
  Supplemental Preferred Questions
INS-1853 Consent and Acknowledgement for Use of Genetic Test Results