To complete your plan review, I need some specific information. Please complete the brief Medicare Checkup Form (also known as our Intake Form). This provides me with the information I need to make my recommendations. The form is HIPAA-compliant and CMS approved. Please have your Prescription Medication information and your Doctor's info handy before you start.

How to fill out your Medicare Checkup Form:

When you hit "submit" you'll see this screen next:

After clicking the Medicare Checkup Form Button below, you'll see this screen:

Click the "Complete Intake Form" link to give me the info I'll need to research plans for you.

That's it! I'll review your info, research plans that will work for you, and we'll set up an appointment to go over everything. I look forward to helping you!