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What kind of insurance are you looking for?

¿Qué tipo de seguro estás buscando?

Individual

Familia

When is your birthday?

¿Cuándo es tu cumpleaños?

How do you file your taxes?

¿Cómo presenta sus impuestos?

Single (Soltero(a))

Married (Casado(a))

Head of Household (Jefe de hogar

Married - File Seperate (Casado - Archivo separado)

Do you claim dependents?

¿Reclama dependientes?

Please input ages here:

Por favor ingrese las edades aquí:

If a person does not apply, please enter "N/A".

Annual Household Income

Ingreso anual del hogar

$

Do you currently see a doctor?

¿Visitas actualmente a un médico?

Yes

No

What's your doctors name?

¿Cómo se llaman sus médicos?

Gender

Género

Male

Female

Last Step

Último paso

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