How to Complete the Preliminary Information Form

Your personal information is required for me to complete a Medicare quote or prepare an analysis of Medicare plans. This detailed information will enable me to provide better service and narrow the plans that best fit your needs and budget.

NOTE: It is important that you include your prescriptions and doctor’s names to help me quote plans that include your prescriptions and doctors.

Please Click the tab below to open the Preliminary Information form for you to fill out, save this form onto a new file, and email the completed saved file back to me at don@MyMedicareSearch.com

But before you click the “Preliminary Information Form” below, if you would rather provide your information by telephone call, please call me at (561) 559-7153 or click the Calendly site at https://calendly.com/don-medicare-advisor/15min to schedule a 15-minute telephone call that’s convenient for you (I will call you at your appointed time).

After opening the “Preliminary Info” | First: fill in your information | Second: save it as a separate file to your computer – | Third: email the saved file to me at don@MyMedicareSearch.com

or telephone me at (561) 559-7153 for assistance

Open Preliminary Information Form to Complete-Save-Return

On the Preliminary Information Form, you have different types of Medicare plans listed to check. Check mark the plan or plans that you want to review.

You will receive separate quotes for each type (HMO & PPO) of Advantage plans and another for Supplement (Medigap) plans. A PDP (Prescription Drug Plan) is also needed with a Supplement plan. If you check the Form requesting a PDP, this quote will also be separate.

Please feel free to call or email any questions.

or telephone me at (561) 559-7153 for assistance

Open Preliminary Information Form to Compete-Save-Return