Legacy Pre-Appointment Requirements
Thank you for scheduling to meet with Legacy Health Insurance! Please complete an Intake Form, Scope of Appointment and Current Medication Form at least 24 hours in advance of your appointment and reach out to us at 952.922.5677 with any questions.
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 email@example.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.
Please click on the button below to complete and submit a client intake form.
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 firstname.lastname@example.org, 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.