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HAVE YOU FILLED OUT YOUR REQUIRED PRE-APPOINTMENT FORMS YET?

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Scope of Appointment

The Scope of Appointment is a federally required form used to document an appointment between an insurance agent and a Medicare beneficiary to ensure that no other types of products are discussed outside of what the beneficiary originally requested.

 

​Please click on the button below to download a printable Scope of Appointment form.E-mail completed form to: info@legacyhim.com, fax to 952.657.7523 or text completed form to 952.922.5677 at least 24 hours prior to your scheduled appointment.

 

If you are unable to print or sign electronically, please let us know immediately so we may send a hard copy in the mail. 

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Intake Form

Please click on the button below to complete and submit a client intake form.

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Current Medication Form

It’s important we know of any regular prescriptions you are on so we may run a cost analysis with our carriers. Please e-mail your current medication list to: info@legacyhim.com, fax to 952.657.7523 or text to 952.922.5677 at least 24 hours prior to your scheduled appointment. Alternatively, you can click on the button below to complete and submit an Rx list in just a few minutes!

 

​If you are not currently taking any prescription medications you do not need to do anything.