Forms

SCOPE OF SALES FORM

Scope of Sales Appointment Confirmation

The SCOPE provides permission for us to talk about Medicare; the signature is valid for 12 months.

To be able to talk to me now or for the following year, please complete a SCOPE form.

Click: GO TO SCOPE FORM

• Enter Your email
• Go to your email – open email from Dropbox
• Review Document
• Best practice: click all boxes – Sign and Date
• A Representative is needed if you are acting as a Power of Attorney
• Top Right: Continue
• Top Right: I Agree

A completed form will be emailed to you.

RX LIST FORM

2025

This voluntary form allows me to research your part D options.

Use the name of the drug you use. Incorrect use of the brand or generic name; could result in purchasing the wrong plan.

For occasion use prescriptions, indicate an amount per tube, pill, shampoo, ointment, etc. such as: 2 tubes per year; 15 pills every 6 months, 2 15ml bottles every 3 months, etc.

Complete a second form if you have more scripts than allowed on one page.

Click: GO TO RX LIST FORM

• Enter your email
• Go to your email – open email from Dropbox
• Review Document
• Complete Form
• Top Right; Continue
• Top Right: I Agree

A completed form will be emailed to you.