Printed Questionnaire

It is recommended that most users fill out an Interactive Questionnaire. However, BenefitsCheckUp also provides the option to print and fill out a questionnaire by hand. Using your printer, you can obtain a paper-based copy of the questionnaire quickly and easily. You can then take it with you 'on-the-go' -- whether for yourself or a loved one.

After you've filled out the questionnaire, come back to this page and enter the answers using the “Go!” button on the lower right.

Please choose from the two options below:

Get a Printed Questionnaire

Enter your zip code and click “Go!” to get your printed questionnaire.


Enter Printed Questionnaire Information

Enter the zip code from your printed questionnaire and click “Go!” to get started.