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NextGen Long-Term Care, Inc. respects your right to privacy. Your information is used by our licensed professionals to calculate your quote, check for discounts, and contact you about your request. Review our Privacy Policy and Terms of Use for more information. As you will read in our policy, we ask you to provide us with your age, gender, and partner status. This is important because quotes are based on age, gender, and health (in addition to the initial benefit amounts requested). Your contact information is required to communicate with you and provide the requested information. A licensed professional may call or email you with follow-up questions to facilitate your request, please provide correct information on this form. Thank you for your understanding.