Impaired Risk

• For specific Ailments:

1. First, select the correct form from the following list. Print the form and fill it out by hand.

Alcohol Usage Cancer Chest Pain Depression Diabetes Driving Violations

Drug Usage General Purpose Heart Disease Stroke Tobacco Usage

Click here to complete a Preliminary Inquiry

2. Then use the following link and print out the authorization form. This requires your signature.
• Authorization Form


3. Send both forms by fax to (412) 351-5310.
   
   

Or mail to: Robert D. Fink And Associates Insurance Center 990 Greensburg Pike East Pittsburgh, PA 15112

For Contracting Click Here

• See below for product information and case studies:
  
  

Product Information:
Sample Case Studies: