MedMax - Contact Us

... Health Insurance that is affordable and easy to understand ... ¡NEW! Four Health Insurance Plans with Critical Illness to choose from ... ¡NEW! No medical questions or physical exams to qualify ... ¡NEW! Guaranteed Acceptance with Inpatient and Outpatient Surgery Benefits including Anesthesia ...

MedMax^tm
Health Benefits

Home	Benefits	Critical Illness	Dental	Prescriptions	Diagnostics
Brochure	Eligibility	FAQ	Enroll	Contact Us

Questions about Med+Max^tm Health Insurance Plans?

If we have not answered all of your questions or

you would like to have one of our licensed representatives contact you and/or give you a free quote

please fill out the following request form:

Required ()**

Are you insured?	Yes	Why do you want to switch?
	No	How long has it been since you had coverage and why now?
Have a Social Security Number?	Yes No
Have a checking account?	Yes No
Taking any medications?	Yes No	If yes, list the treatments and medications you are taking
Type of coverage wanted?	Individual Family Group	If group - number of employees
Anyone bilingual in your home?	Yes No

** First:
** MI:
** Last:
** Address:
** City:
** State:
** Zip:
** Phone:		Best time to call:
xxx-xxx-xxxx
** Email:
	Gender	Date of Birth
** Applicant:
Spouse:
Child:
Child:
Child:
Child:
Child:
** Start Date:
		mm/dd/yyyy
If you have a question please give us a brief description below
Questions/Comments:
Thank you so much for your interest in our Health Plans. A representative will contact you as soon as possible.

E-mail: healthinfo@fisgp.com

Finding Health Insurance Coverage has never been easier!

Home Benefits Critical Illness Dental Prescriptions Diagnostics

Brochure Eligibility FAQ Enroll Contact Us