EmailMeForm
Request your Medicare Booklet here.
Please fill out this form to receive your Medicare booklet.
Please note that this site is not affiliated with any government agency.
Please share your name:
First
Last
I need help with the following:
Medicare Options / Education.
My spouse needs help with health insurance as well.
Social Security Questions.
Marketplace Enrollments.
Long Term Care Options.
What month and year were you born?
Email Address:
Address (Street and PO Box if applicable)
Street Address
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State / Province / Region
Postal / Zip Code
Phone
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How would you prefer to be contacted?
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Email?
The best time to catch me is?
Morning after 9 AM
During Lunch
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Weekends, but keep it short.
Please check all that apply:
I am married.
I am single.
I am a veteran.
I am a patriot and love America.
I support law enforcement and public safety..
I receive Medicaid Benefits.
I would like to know more about Extra Help.
Security Question: What do you like best about the President?
Feel free to share a little about yourself:
A little about me? I am a local health insurance agent that works exclusively with individuals and small business owners (and their employees). I have over 20 years of professional work experience and I absolutely love Making Insurance Great Again! While I will work with ANYONE, I especially enjoy working with people planning to retire in the next 5 to 10 years as well as people turning 65 and beyond to help them maximize their Medicare benefits, Social Security, income for life, and retirement planning. Personally, I am a college graduate and hold two degrees in chemistry (long story) and completed several years of work in the world of pharmaceuticals and specialty medical devices before becoming an insurance agent. I am married to my best friend and we are still raising our three awesome, active boys. Our spare time is spent watching them play sports (football and baseball) and enjoying time by our fire pit outside with friends and neighbors. Along with conservative political views and family values, we also unapologetically support and pray for President Donald J. Trump. I really do love this insurance stuff and will gladly take any worry you have about it off your plate. Thank you for reading about me! I am looking forward to meeting you and learning about your journey.
