Health Insurance Place
of Oregon
Specialists in Helping Individuals, Families, and Businesses select Quality Health Care Plans
Put us to work for YOU in finding a plan designed for your needs
instead of the insurance company's!  

Use this form to request a quote.
# of
Children
Sex (M/F)
Date of Birth
Your name:
Spouse name:
Home City:
State:
What type of plan are you interested in?  Check all that apply.
Tradition Health Plans
(Individual/Family/Group)
Medicare Supplements
Health Savings Accounts
(HSA)
Dental
Vision
HMO / PPO
Optional:  if you would like
to tell us about your health
history, medications, or any
other information that will
help us customize your  
plan, you may do so here.
How would you like us to get back to you?
Phone number:
Email address: