WE SERVICE YOU...
Our goal is to service our clients at the highest level possible. In doing so, we touch bases with you every year. We check your doctors, medications and speak with you about your personal needs and how they may change from year to year. This information below will help us serve you better prior to our next conversation.

    Medicare Questionnaire

    Please take a moment to answer these optional questions the best you can to help us prepare for our Medicare Meeting. Plans can differ and change and we want to know what will impact you personally.
    YOUR INFORMATION
    SPOUSE INFORMATION
    By submitting this form, you consent to a follow-up call by Birdseye Financial and their representatives. You acknowledge that we have requested your CONSENT TO CONTACT as per the rules of Medicare.
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