Let's Build a Group Benefits Plan Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Business Name Business Legal Structure CorporationSole ProprietorPartnershipNon-ProfitOtherDetails Number of Employees (Including Yourself)Would You Like to Also Cover the Family Members of Your Employees?NoYesEmployee Survey List the ages of all employees (including yourself) with the ages of their proposed insured family member (if you are choosing to cover them)Are All Your Employees Covered by Government Health Insurance? YesNoWhat Kind of Benefits Would You Like Your Plan?Basic DentalEnhanced DentalBasic Prescription DrugsEnhanced Prescription DrugsBasic Vison CareEnhanced Vison CareBasic Paramedical ServicesEnhanced Paramedical ServicesHome CareMedical DevicesTravel InsuranceShort Term DisabilityLong Term DisabilityLife InsuranceCritical Illness InsuranceHealth Spending AccountGroup RRSP / PensionGroup Discount ProgramDoes Your Business Currently Have a Group Benefits Plan in Place?NoYesI consent to Red Helm Canada and/or BrokerTeam Insurance communicating with me digitally about insurance and related matters *AcceptSubmit