Forms | SIRA

Forms | SIRA

top of page

Wooden Panels

Forms

Whether you are a new or returning client, keeping track of all of the forms you may need to fill out can be overwhelming. Below are some of the forms you may be looking for related to Medicare or Marketplace Health Insurance.

Stethoscope Over Cardiogram

Marketplace Health Insurance Client Packet (Under 65)

To complete this packet, you can request the secure, online platform, DocuSign, or download and print a PDF version of this packet to return to our office.

Medicare Client Packet

(65 & Over)

To complete this packet, you can request the secure, online platform, DocuSign, or download and print a PDF version of this packet to return to our office.

pexels-chepté-cormani-1416530.jpg

Permission to Contact Request

As per federal regulations, we are unable to contact you to discuss Medicare products with you without your authorization. If you are interested in discussing Medicare products with us, please complete the form below.

To complete this packet, you can request the secure, online platform, DocuSign, or download and print a PDF version of this packet to return to our office.

person holding hands of another person_edited_edited.jpg

Scope of Appointment & Prescription Drug Form

To complete this packet, you can request the secure, online platform, DocuSign, or download and print a PDF version of this packet to return to our office.

Prescription Drug

List Form

To complete this packet, you can request the secure, online platform, DocuSign, or download and print a PDF version of this packet to return to our office.

EFT Authorization Request

To complete this packet, you can request the secure, online platform, DocuSign, or download and print a PDF version of this packet to return to our office.

Wooden Panels

Next Steps

If you need help determining which form you may need, contact us or schedule an appointment using our online booking system.

bottom of page