New Client Survey

Welcome to RWR, your Pennsylvania insurance advisor!

We like to believe that a large part of your decision to partner with us is the service you will receive. As we continue our relationship, RWR wants to hear what is important to you. Please take a moment to fill out this brief survey so that we know how best to service your account.

Complete New Client Survey

The purpose of this questionnaire is to understand what you, the new client, expects from our relationship.
Client Information
Primary Contact Name*
First Last
Company Name
Email Address*
What type(s) of insurance do you currently have with us?*
- Personal Insurance
- Business Insurance
What is your preferred method of communication with your insurance provider?*
How often would you like to hear from us?*
- Quarterly
- Semi-Annually
- Annually
- As Needed
Have you used other independent insurance agencies in the past?*
- Yes
- No
What did you like about your experience?*
What did you dislike about your experience?*

What are the most important aspects of an insurance provider when buying insurance products?*

Personal agent assigned to your account	Customer service	Website tools	Price	Communication

Assign a number from 1-5 for each option below. 1 = most important 5 = not important.

Based on your purchasing experience with RWR, would you recommend us to your friends and family?*
Additional Comments
Confirmation
Your initials*
This field is for validation purposes and should be left unchanged.
This field is for validation purposes and should be left unchanged.

The next step is easy, call 814-623-1111 Or, Contact Us

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Medicare Disclaimer:
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Currently we represent 3 organizations which offer 2,985 products in your area. You can always contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program for help with plan choices.

Our agency is authorized to offer Medicare plans in Pennsylvania. For a complete list of plans by state and county, click here: MA Contract Service Area 2023 09 | CMS

Welcome to RWR, your Pennsylvania insurance advisor!

We like to believe that a large part of your decision to partner with us is the service you will receive. As we continue our relationship, RWR wants to hear what is important to you. Please take a moment to fill out this brief survey so that we know how best to service your account.

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Complete New Client Survey

Client Information

Confirmation

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