FAMILY & INDIVIDUAL PERSONALIZED QUOTES

Name:	Gender: Male Female
Smoker: Yes No	Date of Birth (MM/DD/YYYY):
Zip Code:	Email:
Telephone:	Best Way to Contact?: Email Telephone
Spouse's Age:	Is Spouse a Smoker?: Yes No
Type of Insurance Needs or other Information:

If you have a pre-existing condition or special needs of any kind, call us and we will do a confidential search for the best available rate for you.

ADDITIONAL INFORMATION FOR INDIVIDUALS & FAMILIES

Individual health insurance
Contact:
Florida Department of
Financial Services
(800) 342-2762
http://www.fldfs.com

U.S. Government healthcare site
Contact:
http://www.healthcare.gov

Medicaid
Contact:
Florida Agency for Health Care Administration
(888) 419-3456
http://www.fdhc.state.fl.us

Florida Department of Children and Families
Contact:
(866) 762-2237
http://www.dcf.state.fl.us/ess/

Florida KidCare Program
Contact:
Florida KidCare Program
(888) 540-543
(877) 316-8748 TTY
http://www.floridakidcare.org

Florida Breast and Cervical Cancer
Early Detection Program
Contact:
Florida Department of Health
(Family Healthline)
(800) 451-2229
www.doh.state.fl.us/Family/cancer/bcc/index.html

This information will not answer every question for every person in every circumstance, but it might help. In addition, it is not a substitute for legal advice. If you have more questions, contact the agencies or consult an attorney.

POPE INSURANCE • 941-475-6766 • E-MAIL: Carolyn@PopeInsurance.com