Birdseye Financial Services (360) 722-7889
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      • Social Security Webinar
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      • Federal Benefit Kit
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      • Medicare Questionnaire
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Medicare Questionnaire
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.

    Tell us about your  needs...

    Please take a moment to answer these optional questions the best you can to help us prepare for our Medicare Meeting. Each year the Medicare Plans can change as well as your personal needs. So please share these details below so we may better help you in the decision making process.
    Since Medicare is based upon your location, what is your address?
    Your Contact Information

    Tell us about your needs...

    Spouse Information (If Applies)

    Tell us about your needs...

    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. If you are 65 years old or older, we will be required to ask you for an electronically signed SCOPE of appointment prior to our discussions of Medicare. This SCOPE simply allows us to discuss the different types of Medicare plans that you are interested in.  By providing your contact information, you agree to allow a licensed sales person to contact you regarding Medicare options or to enroll in a plan. I understand that the person who will be discussing the plan options with me may e compensated based on my enrollment in a plan. ​
Submit
Thank You for your submission...
IMPORTANT DATES FOR MEDICARE
Retiring from an Employer
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When your turning age 65
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Annual Changes to Medicare
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We appreciate your Online Review!
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Phone 360-722-7889
Fax #425-412-6865
INFO@BIRDSEYEFINANCIAL.COM
Birdseye Financial (MAP)
The contents of this website are for educational purposes only. Any material and its attachments, links, downloads, and/or any emails from our company are not intended to provide legal or tax advice. To ensure compliance with requirements imposed by the IRS, we inform you that any U.S. federal or state tax advice contained in this communication (including any attachments) is not intended or written to be used, and cannot be used, for the purpose of (i) avoiding penalties under the Internal Revenue Code or (ii) promoting, marketing, or recommending to another party any transaction or matter addressed herein. Please seek the advice of appropriately licensed individuals for legal or tax advice relating to your individual situation. Birdseye Financial and its employees are not tax or legal advisors and are not operating in such a manner. Birdseye financial and those working for the company are not licensed Investment Advisors which prohibits us from offering such advice. Any advice you get should be taken as non-investment advice and only educational in nature. Should our clients need a licensed investment advisor, we often work with Secure Investment Management. *Investing carries an inherent element of risk. No strategy can guarantee a profit or prevent a loss. Provided content is for overview and informational purposes only and is not intended and should not be relied upon as individualized tax, legal, fiduciary or investment advice. Any individuals used in scenarios are fictitious and all numeric examples are hypothetical and were used for explanatory purposes only. THANK YOU!
  • Home
  • About
    • Welcome to Birdseye
    • Who We Are
    • Risk & Portfolio Assessment
    • Request Free Consultation
  • Strategies
    • Key Components
    • Sequence of Returns
    • Rule of 100
    • Tax Strategies >
      • Tax Saver Calculator
      • RMD Calculator
      • Qualified Charitable Donation
      • Medicare Tax Deductions
    • Webinars >
      • Economic Strategy Webinar
      • Five Key Areas of Retirement Webinar
    • Video Library
  • Planning
    • Retirement Analysis >
      • Retirement Meeting
      • RA Analysis
    • Social Security >
      • Social Security Webinar
    • Pension Maximization
    • Risk Analysis
    • Risk Investments
    • Secure Investment Management
    • Federal Benefits >
      • Federal Benefit Kit
  • Insurance
    • Annuities
    • Medicare >
      • Medicare Questionnaire
      • Medicare Meeting
      • Medicare Networks
    • Long-Term Care
    • Life Insurance
    • Final Expense
    • Health Insurance
    • Dental Insurance
    • Vision Insurance
  • Tools
    • Financial News Blog
    • Documentaries
    • Market Index Links
    • Required Minimum Dist (RMD Calculator)
    • Calculators
    • Professional Referrals
    • Bankrate Interest Rates
    • Zillow Home Value
  • Contact
    • Free Consultation
    • Schedule Appointment
    • Online Meeting >
      • Online Meeting Details
    • Secure Upload
    • Retirement Analysis
    • Retirement Portal
    • Rate our Service
    • Referral A Friend