---
title: Long-Term Care Insurance Application Form Template | Paperform
description: Professional long-term care insurance application template with health assessment, family history, care preferences, and benefit selection. Streamline underwriting and improve application completion rates.
url: "https://paperform.co/templates/long-term-care-insurance-application"
type: static
generatedAt: "2026-03-28T00:44:24.290Z"
---

[← Back to free form templates](/templates/)    ![Long-Term Care Insurance Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/long-term-care-insurance-application.png)
    [Preview](https://_preview.paperform.co/ai-template/long-term-care-insurance-application) [Use this template for free](/create?ai-template=long-term-care-insurance-application)    [Financial & Accounting Forms](/templates/category/financial/)[Industry-Specific Forms](/templates/category/industry-specific/) [Senior Care](/templates/industry/senior-care/)[Finance](/templates/industry/finance/)[Insurance](/templates/industry/insurance/) [Broker](/templates/role/broker/)[Financial Advisor](/templates/role/financial-advisor/)[Insurance Agent](/templates/role/insurance-agent/)[Underwriter](/templates/role/underwriter/)     About this free form template
### Simplify Your Long-Term Care Insurance Applications with Paperform

Planning for future care needs is one of the most important decisions your clients will make, and your long-term care insurance application process should reflect the care and professionalism your organization stands for. This **Long-Term Care Insurance Application** template is designed specifically for insurance agencies, brokers, and carriers who need to collect comprehensive applicant information while maintaining a smooth, professional experience.

#### Built for Insurance Professionals Who Value Efficiency

Whether you're an independent insurance broker, part of a larger agency, or working within a carrier's underwriting team, this template streamlines the entire application process. Instead of juggling paper forms, follow-up emails, and incomplete submissions, you can collect everything you need in one organized, digital workflow.

The form guides applicants through essential sections including personal information, detailed health assessments, family medical history, activities of daily living, care preferences, and benefit period selections—all presented in a clear, logical flow that reduces abandonment and increases completion rates.

#### Why This Template Works for Insurance Applications

**Comprehensive without being overwhelming:** The form breaks complex health and coverage questions into manageable sections, using conditional logic to show only relevant follow-up questions based on previous answers. If an applicant indicates a pre-existing condition, additional detail fields appear automatically. This keeps the form feeling shorter while ensuring your underwriting team gets the complete picture.

**Professional and brand-aligned:** Using Paperform's doc-style editor, you can customize fonts, colors, headers and imagery to match your agency's branding. Whether you embed this form on your website or send it as a standalone link, it maintains the polished, trustworthy appearance that insurance clients expect.

**Designed for accuracy:** With built-in field validation, required questions, and clear instructions, you'll dramatically reduce incomplete or inaccurate submissions. The form includes dropdown menus for standardized medical conditions, yes/no toggles for quick responses, and text fields for detailed explanations—giving applicants the right input method for each question type.

#### Perfect for These Insurance Use Cases

 - **Individual long-term care policy applications** for agents working with families planning for future care needs
 - **Group LTC enrollment** for employers offering long-term care benefits
 - **Policy renewals and updates** when existing policyholders need to modify coverage
 - **Pre-qualification assessments** to help prospects understand their eligibility before starting a full application

#### Streamline Your Workflow with Automation

Once you've captured an application, Paperform makes it easy to connect to your existing insurance tech stack. Send submissions directly to your CRM (HubSpot, Salesforce, Pipedrive), create records in your agency management system, or route applications to underwriters via email notifications with all the details they need.

For agencies managing complex approval workflows, consider connecting this form to **Stepper** (stepper.io)—Paperform's AI-native workflow builder. You can automatically route applications based on age, health conditions, or benefit amounts, trigger follow-up tasks for your team, request additional medical documentation, and keep applicants informed throughout the underwriting process.

If your application process requires signed agreements or disclosure forms, integrate **Papersign** (papersign.com) to automatically generate policy documents from form submissions and collect legally binding eSignatures—all tracked back to the original application for a complete audit trail.

#### Built-In Payments for Application Fees

If you collect application fees or initial premiums, Paperform's native payment integrations with Stripe, PayPal, and Square let applicants pay securely within the same form. No redirects, no separate invoicing—just a seamless experience that increases conversion and reduces administrative work.

#### Data Security Your Clients Expect

Long-term care applications contain sensitive health and financial information, which is why Paperform is **SOC 2 Type II compliant** and offers robust security features including SSL encryption, data residency controls, and secure submission storage. While Paperform is not HIPAA compliant, it provides the professional-grade security that insurance agencies need to protect client data and maintain trust.

#### Who This Template Is Perfect For

This Long-Term Care Insurance Application template is ideal for:

 - **Insurance agents and brokers** specializing in long-term care, senior care planning, or elder law
 - **Insurance carriers** looking to digitize their application process and reduce processing time
 - **Financial advisors** who include LTC planning in their retirement and estate planning services
 - **Employee benefits consultants** managing group long-term care programs
 - **Senior care organizations** that partner with insurance providers

#### Get Started in Minutes

With Paperform's intuitive editor, you can customize this template to match your specific underwriting requirements, state regulations, and benefit options in just minutes. Add or remove questions, adjust conditional logic, update benefit period options, and modify coverage amounts to perfectly match your product offerings.

Join over 500,000 teams worldwide who trust Paperform to handle their most important business processes. Whether you're processing 10 applications a month or 1,000, this template scales with your business while maintaining the professional, personal touch that sets great insurance agencies apart.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
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