Download Medical Assessment Form
Please complete the Covermore Medical Assessment Form for any conditions that require approval before cover can be offered. If you wish to obtain cover for a heart condition your physician needs to complete the Medical Assessment Form for heart conditions. All questions must be answered to enable assessment.
If you require help with the completion of this form, please consult your doctor for medical information or Travelinsure for other details.
If you are over 18 years of age, this form must be signed by you, if someone is signing on your behalf, we will require a copy of the legal authorisation that indicates that they may do this for you (eg Power of Attorney documents).
If your doctor completes any question on this form for you, they must sign the doctors declaration. You must still sign your medical authority and declaration.
Any costs associated with submission of this application are your responsibility.
Download Medical Assessment Form for Options and Business Policies:
Medical assessment form for those wishing to take out a CoverMore Options, Travelsure and Business Travel Insurance policy.
Download Medical Assessment Form for Essentials Policy:
Medical assessment form for those wishing to take out a CoverMore Essentials Travel Insurance policy
Once you have completed this form please return it to Travelinsure, Shop 5, The Strand Village Centre, Mt Eliza VIC 3930 or FAX it to us at (03) 9787 1145. Within a few days of receiving application a letter will be sent advising of Cover-More's decision or one of our nurses will telephone you.
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