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Your Local Healthcare Benefits Specialist

Dave Burlew

Northern Michigan
Health Plans

Thompsonville, MI 49683
1-888-546-3460
9 am - 8 pm
Monday - Saturday

Offering the best health insurance options for Individuals, Families, Employer Groups, Seniors, Life, Disability and International Plans.

Email Dave For More Information

Individual & Families Quote Request

Complete the form below and press the Submit Proposal Request button at the bottom. An agent will contact you with your quote. Please be assured that your information will be kept strictly confidential in accordance with our privacy policy, and will not be sold for any purpose.

Personal Information
Name:
A name is required.
Business Name:
Type of Business:
Address:
An address is required.
City:
A city is required.
State:
Please select a state.
Zip Code:
A zip code is required.
County:
A county is required.
Email:
An email is required.
Phone Number:
A number is required.
Best time to call:
Primary Male
Date of Birth:
Height:
Weight:
Smoker?
Primary Female
Date of Birth:
Height:
Weight:
Smoker?
Number of Children to be insured:
Any known Medical Conditions?
Taking any medication(s)?
Is anyone currently pregnant?
Give details of all conditions with exact diagnosis, dates of treatement, all medications, and prognosis: