TestPoint Online Medical Services

Ordering Online Services (for Agents)

TestPoint Medical provides a full line of Paramedical services for underwriting purposes. Our affiliations with the country's top providers of examination, medical, and diagnostic testing and data information services give us the approval to do testing for all insurance companies nationwide. Now even better you can order them directly online. Start by filling out the form below.

If you prefer filling out the order form and faxing it in, click the link to the right. You can also fill in the pdf and email it to us as well

1 of 2 | Applicant Information

TestPoint Online Medical Services
  • First Name*
    Last Name*
    SSN*
    Date of Birth* (mm/dd/yyyy)
    Address*
    Address Two
    City*
    State*
    Zip Code*
    *At Least one of the following (3) three fields MUST be filled in.
    Home Phone
    Work Phone
    Mobile Phone
    Email Address
    First Name (Applicant 2)*
    Last Name*
    SSN*
    Date of Birth* (mm/dd/yyyy)
  • Order Form for Agents (Insurance Info)
    Insurance Company (separate multiple with ";")*
    Type of Insurance*
    Insured Amount (per month)*
    Additional Insured Amount (spouse/co-worker)
    Agency
    Insurance Agent (agent's first/last name)
    Brokerage Case (broker’s first/last names)
    Agent Code*
    Agent’s Address*
    Agent’s Phone Number*
    Agent’s Fax Number (if applicable)
    Agent’s Email Address
    Comments or Instructions (from agent)
    Enter Code In Textbox*