Long Term Care Insurance Quote Request Ensuring your loved one is cared for as they age can help bring peace of mind. If you’re looking for a quote for long term care for you or a loved one, enter some information below. Jankowski will get started on your long term care insurance quote. Long Term Care Insurance Form Name (required) Email (required) Phone Supporting Documents Date of Birth Gender MaleFemale Do you use tobacco? YesNo Income during retirement Approximate assets Message Supporting Documents (Optional) Upload a photo or copy of your existing policy