Form FAQs

Answers to common questions about forms. To skip the FAQs and fill out your forms, scroll down or click here.

The Medicare form includes three forms: a Prescription Drug form; Scope of Appointment; and an Engagement Letter.
Yes, Medicare continues to add requirements for brokers. Even if you take no drugs, all three forms are required before we can add you to the reservation list.

We will start calling clients in October to set up appointments.

Check the top three Medicare plans that you want to review during open enrollment.
Once you check off the plan type, you can then add your initials on the box that appears in the right- hand corner.

The forms are located on this page, just below these FAQs. Click here to scroll to the forms.

We are currently processing all submitted forms. Please note that it may take a few days to process your forms, but we will notify you as soon as you are added to the reservations list. Thank you for your patience.
Please list all drugs you would like to receive an accurate estimate for. Plans can vary widely if prescriptions are not included. If you have drugs you take occasionally, put them on the list with an approximate number of times filled annually.
Yes you can! To find out how, see our article entitled “How to Review Your Medicare Prescription Drug Plan.”

Medicare Forms

The Medicare form includes three forms—a Prescription Drug form, Scope of Appointment, and Engagement Letter. Please fill out all three forms to advise us as to which Medicare plans you would like an agent to discuss with you.

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Download the PDF

Under 65 Form

This letter presents your engagement with Susan Polk Insurance, including a disclaimer and waiver regarding electronic data transfers.

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  • All information is entered, submitted, transferred and stored securely.

Download the PDF