Find which Medicare Advantage plan works best for you

Contact Information: (We Service Connecticut Residents Only)

Name
Address Street
Town/City Zip Code
Date of Birth (mm/dd/yyyy)
Gender Male Female
Email Address
Phone Number Extension

Please send me information on Medicare Advantage plans
in my area which my doctors participate in.

Doctor #1   Name Type of doctor Office zip code
Doctor #2   Name Type of doctor Office zip code
Doctor #3   Name Type of doctor Office zip code
Doctor #4   Name Type of doctor Office zip code
Doctor #5   Name Type of doctor Office zip code
Doctor #6   Name Type of doctor Office zip code

I would also like to considering my particular current prescriptions when helping me choose a plan.
This is optional, of course. But we advise considering your prescription use when comparing plans. Some plans may provide
better coverage for your prescriptions than other.

List All Prescriptions Below:

Prescription #1   Name    dosage     times daily once per week once every two weeks once every month once daily twice a day three times daily four times daily five times daily
Prescription #2   Name    dosage     times daily once per week once every two weeks once every month once daily twice a day three times daily four times daily five times daily
Prescription #3   Name    dosage     times daily once per week once every two weeks once every month once daily twice a day three times daily four times daily five times daily
Prescription #4   Name    dosage     times daily once per week once every two weeks once every month once daily twice a day three times daily four times daily five times daily
Prescription #5   Name    dosage     times daily once per week once every two weeks once every month once daily twice a day three times daily four times daily five times daily
Prescription #6   Name    dosage     times daily once per week once every two weeks once every month once daily twice a day three times daily four times daily five times daily
Prescription #7   Name    dosage     times daily once per week once every two weeks once every month once daily twice a day three times daily four times daily five times daily
Prescription #8   Name    dosage     times daily once per week once every two weeks once every month once daily twice a day three times daily four times daily five times daily
Prescription #9   Name    dosage     times daily once per week once every two weeks once every month once daily twice a day three times daily four times daily five times daily
Prescription #10 Name    dosage     times daily once per week once every two weeks once every month once daily twice a day three times daily four times daily five times daily

Pharmacy(s) of choice:

Pharmacy #1  Name Zip code
Pharmacy #2  Name Zip code
Pharmacy #3  Name Zip code

Please contact me, I have questions.

Call me to schedule an appointment.