• About you

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About you

We just need a few personal details to help us create your quote.

Personal details

Contact details

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Cover start date

So we can get you the right price

Any previous medical conditions?

In the past five years, have you had, or received treatment* for:

  • Heart condition or problem
  • Stroke
  • Cancer
  • Diabetes
  • Mental illness, including depression, that has required referral to a specialist



  • * By treatment, we mean surgical or medical services (including medication prescribed by a specialist) that are needed to diagnose, relieve or cure a disease, illness or injury.
  • A specialist is any doctor (including psychiatrists) who is not your GP.
  • This applies whether the treatment was received privately or under the NHS.

Are you a tobacco user?

Have you used any tobacco products within the last 12 months?

By ‘tobacco products’ we mean smoking or chewing tobacco – not using e-cigarettes or vaporizers.


If you are adding anyone else to your cover we will ask the same questions about them. Please take care to give accurate and complete answers for all members you have permission to speak to us about and who are to be covered by the plan.

Now: let's work out a price that suits you

Please note that when you get a quote a member of the AXA team will contact you to discuss it with you.

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Need help?

If you want to have a chat give us a call on

0800 587 0953

Lines open Mon-Fri 9am-8pm. We may record and/ or monitor calls.

Need help? If you want to have a chat give us a call on 0800 587 0953 Lines open Mon-Fri 9am-8pm. We may record and/ or monitor calls.