Scope of Appointment
Emina Qira · The Qira Agency
Why I'm asking you to complete this: Federal Medicare rules require me to document, in writing, which types of Medicare plans you'd like to discuss before we have an appointment that covers Medicare Advantage or Part D prescription drug plans.
You control what gets discussed — I can only talk about the plan types you check below. This doesn't obligate you to enroll in anything, and you can end our appointment at any time.
Scope of Appointment Form
Please complete before our scheduled appointment
What happens when you sign: Submitting opens a pre-filled email in your device's mail app, addressed to me, with the plan types you selected, your typed signature, and the date. Sending that email creates your dated Scope of Appointment record. This form is valid for 12 months from the date signed for the product types checked.
Questions before we meet?
Let's Talk — 201-446-8302