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  1. Please download and fill out the Excel census and group information. (Please include all employees in the census.)
  2. E-mail the completed Excel file back to us at info@healthcarespecialists.biz
  3. One of our licensed brokers will contact you regarding a group health quote.

If you do not have all of the census information at this time but would like a quote, please complete the section below so we can contact you for the remaining information.

You must enter all information fields with an *asterisk and the verification code, or the form will not be processed.

*Company Name:
Type of Business:
Zip:

*Contact:
*Email:
*Phone:
Fax:

Number of Employees:

*Code:






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