Forms · Current clients
Prescription drug questions
If you have a Supplement (Medigap) plan, a stand-alone drug plan (Part D), or both. Take as long as you need — you’ll get a chance to check it all before anything is sent.
About you
We ask for all of these so Barb can match this form to your record without having to ring you.
1.) How do you feel about your current plan?
2.) What are your current prescriptions?
People usually remember to list all their prescription tablets and capsules but often forget to include things like their insulin, nasal sprays, asthma inhalers, creams and ointments.
DON'T include medications that are OTC (over the counter) or you get at the VA or that Worker's Comp pays for
Medicine 1
Medicine 2
Medicine 3
Medicine 4
Medicine 5
Medicine 6
Medicine 7
Medicine 8
Medicine 9
3.) Do you receive Extra Help for your prescriptions:
Stuck? Call Barb on (216) 287-8832.