Benefits Consultation Intake

This intake is reviewed by Greg Knight, Senior Vice President at Wheeler & Taylor Insurance.

It’s used to get a clear picture of your business and current benefits setup so we can put together a practical, tailored recommendation.

Business Basics

Tell us a bit about your business.

First Name *

Last Name *

Business Name

Email Address *

Phone Number *

Company Profile

Number of Employees *1–1011-2526-5152-100100+

Industry *0 / 250

Current Situation

Do you currently offer benefits? *YesNo

What Do You Offer? *HealthDentalVisionOther

What Challenges Are You Facing Today?

Current Challenges *Rising costsLow employee participationToo much HR adminEmployees don’t understand benefitsNot offering enough

What Are You Interested In?

What are you most interested in? *Voluntary benefits (no employer cost)Improving enrollmentHR / onboarding tools

Review & Submit

Just one final step to get your quote started.

Please take a moment to review your information before submitting. This helps us ensure your quote is accurate and tailored to your needs.

I confirm that the information provided is accurate and complete to the best of my knowledge.

I agree to be contacted to discuss this request and review coverage options.

I understand that this is a request for a quote and does not bind coverage.

Initial

Enter your initials as confirmation of the above statements. *0 / 10

Submit Your Request

Once submitted, I’ll personally review your information and reach out with next steps and coverage options that make sense for your business.

Best,
Greg Knight
Senior Vice President
Wheeler & Taylor Insurance

Please do not fill in this field.