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 firstname.lastname@example.org
or regular mail at 12401 Riverside Rd Caldwell ID 83607.
THANK YOU! I LOOK FORWARD TO ANSWERING ALL YOUR QUESTIONS.