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1.800.854.4099 | 724.458.7255
Davevic Benefit Consultants, Inc.

Individual Coverage

Choosing an affordable insurance plan is not as easy as it once was. There seem to be so many different options available and it can be overwhelming trying to decide where to begin.

Our expert staff is ready and able to assist you. If you have any questions, or if you would like more information on our services, please give us a call.

1.800.854.4099
Health Coverage Quote
Please use this form to submit a quote request. A licensed representative from our company will contact you about your request.


*REQUIRED FIELD
* First Name
* Last Name
Email Address
*Birthday (mm/dd/yyyy)
Gender
Street
City
State
Zip Code
*Telephone
Spouse Name
Birthday (mm/dd/yyyy)
Children
Ages, If Answered Yes
*Desired Benefits
Tobacco Usage
Have you ever used tobacco or nicotine products (i.e. Patch/gum)?
*If yes, provide details regarding type/frequency of use, and dates of use (i.e. 2000-present)


Any known medical conditions or regular medications?


Agent Name
Name
Telephone
Email
Thank you. Your quote request has been submitted.
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