Due to a new Medicare rule from October 1, 2023, we are now required to obtain a permission slip before we can review ALL of  your options for your upcoming appointment. 

This form must be signed at least 48 hours before we can meet with you about Medicare options.

Please fill out this “Scope of Appointment” permission form so we can discuss all of your options.

Please leave all options on the forms checked:

Note: If you get another opportunity to book another appointment, you can skip that part. We just need to keep this permission form on file now. Thank you! 

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