Secured by SSL

Request for Individual & Family Health Insurance Quote


Please provide the following information in order to streamline the process in receiving a quote for Health Insurance. Please provide Dates of Birth for all of those seeking coverage and whether or not they use tobacco. A representative will reach out to you shortly to review your request and gather any additional information you would like to provide. 

First Name
Required
Last Name
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
E-Mail Address
Required
Date of Birth - Primary Insured
Required
/ /
Date of Birth - Spouse
Optional
/ /
Date of Birth - Dependent
Optional
/ /
Date of Birth - Dependent
Optional
/ /
Tobacco Used? - Primary Insured
Required
Tobacco Used? - Spouse
Optional
Tobacco Used? - Adult Dependent
Optional
Are you interested in learning if you qualify for a tax credit to help offset your premium costs?
Optional
Please list any medical providers that you would like to ensure access to at in-network rates:
Optional
What is most important to you about your coverage? For example, low cost, access to your physicians, a certain deductible level, etc.
Optional
Submission Validation
Required
CAPTCHA
Change the CAPTCHA codeSpeak the CAPTCHA code
 
Enter the Validation Code from above.
Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.







           
717 Manatee Ave W. , Suite 300
Bradenton, FL 34205
Ph: (941) 745-8300
Fx: (941) 745-2571

 
   
Our Company
Our Team           
Our Carriers

In The News
Blog

Applications
Programs/Specializations
Claims


Applications
High Value Homes
Claims





Applications
How to Choose A Plan
Life Insurance
Annuities
Group Insurance 




Nicholas Zec, Jr., James E. Boyd, David Grantham, and Kristy Terenzio are Registered Representatives of LaSalle St. Securities LLC, a registered broker/dealer. Securities are offered through LaSalle St. Securities LLC, Member  FINRA/SIPC, 940 N. Industrial Drive, Elmhurst, IL 60126-1131. Boyd Insurance & Investment Services is not affiliated with LaSalle St. Securities LLC. Investing involves risks, including the risk of principal loss.