The First Two Minutes Trauma Center

Every (26) Seconds, An Accident Happens...

**To See If You *Qualify For A Plan To Offset Your Financial Trauma,**

In The Event Of A Catastrophic Catastrophe, At Virtually No Cost To You,

For Less Than .34¢ An Hour…

Please Complete The Following

Recovery No D.

Name

First

Last

Date Of Birth

Cell Phone

Address

A. If You Were In A Coma, As A Result Of A *Catastrophic *Accidental Brain Injury, In Over The Last 12-18 Months, When You Came Out, What Would Your Life Look Like?

B. For Less Than .34¢ An Hour, In The Event Of A *Catastrophic Accident .. If You *Qualified For a Hardship Recovery Checkbook...At Virtually No Cost To You, Providing That You *Qualify, Would You Take Advantage Of It?

C. If You Were Confined To A Hospital, As A Result Of A Catastrophic Accident, Would You Want To Get Paid Per Day Or Remain Void Of Income, While Confined In The Hospital?

Get Paid Per Day
Remain Void Of Income

D. How Many "I HATE TO INFORM YOU" Checks.. Will *Life Write Today?

*Answer; EVERY 2 SECONDS, *WE DON'T KNOW!

E. In The Event Of A *Catastrophic Accident, If You Could Use Our Money, Oppose To Using Your Money, To Offset Your Financial Hardship, As A Result Of A Catastrophic Accident, At Virtually No Cost To You, Providing That You Qualify, Would You Take Advantage Of It?

F. In The Event Of A Catastrophic Accident, How Long Could You Wait For Compensation/ Proceeds?

3 to 5 Years?
Or 30 Days?

IN THE EVENT OF A CATASTROPHIC ACCIDENT OR CRITICAL ILLNESS, TO ASSIST US IN YOUR QUALIFYING, PLEASE TELL US, WHO WOULD SPEAK ON YOUR BEHALF WHEN YOU'RE NOT ABLE TO SPEAK FOR YOURSELF?

Emergency Contact

First

Last

Relation To Patient

Phone

Every (26) Seconds, An Accident Happens...

**To See If You *Qualify For A Plan To Offset Your Financial Trauma,**

In The Event Of A Catastrophic Catastrophe, At Virtually No Cost To You,

For Less Than .34¢ An Hour…

Please Complete The Following

IN THE EVENT OF A CATASTROPHIC ACCIDENT OR CRITICAL ILLNESS, TO ASSIST US IN YOUR QUALIFYING, PLEASE TELL US, WHO WOULD SPEAK ON YOUR BEHALF WHEN YOU'RE NOT ABLE TO SPEAK FOR YOURSELF?

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