Appointment preparation
Complete the Medicare Questionnaire
This questionnaire is for people preparing for a Medicare planning appointment with our office.
Important: The questionnaire helps us review your timeline, current coverage, prescriptions, doctors, and planning questions before we meet. The secure form is powered by Jotform. This website does not store questionnaire answers or send them by regular email.
When to use this form
Please complete this questionnaire only if you are preparing for a Medicare planning appointment or our office has asked you to do so. If you are still browsing and want general education, start with the Medicare resources or schedule a planning call first.