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Client Intake Form
Please be sure to provide all of the required information.
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Prescription Analysis Form
If you would like us to do a comprehensive analysis of your out of pocket costs for your medications, along with the drug plans available to you, we are happy to assist with that. To do that, we will need you to include all medications you take along with the daily dosage, how often you fill the Rx and the pharmacy you use. *Be sure to note if you take the Brand name or Generic. If you use an inhaler, please bring the inhaler to your appointment. If you use insulin, please note the vial units/ml and how many you use per month. If you are not comfortable providing us with that information, happily disregard.
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Scope of Appointment
This document protects you by keeping us compliant with Medicare, stating that we will only be discussing Medicare health care options with you, and no other lines of insurance, such as home and auto insurance, etc. Please note that this form is required by Medicare, 48 hours prior to the time of your appointment. Please be sure to electronically sign the form.
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