Please print this form, it is a SCOPE OF APPOINTMENT.

We use this form to designate what items you wish to discuss with me for your MEDICARE OPTIONS.

Please initial the boxes you wish to discuss.

Return the completed, signed form to me by email at karrin@archerbenefits.com

or regular mail at 2879 Denise Ave Twin Falls, ID 83301.

THANK YOU!    I LOOK FORWARD TO ANSWERING ALL YOUR QUESTIONS.

Karrin Archer