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(919) 390-1880 or toll free (888) 985-0014

Health Questionnaire Form

Looking to switch your Medigap plan? I'll need to know how your health has been over
the past few years to do an analysis of your chances of an approval.

Please download, print and fill out the form below and get it back to me. 

Health Questionnaire 


1. General dates for the medications is fine. You do not have to be perfect

2. Be honest but we don't put things down that are not pertinent. Answer ONLY the questions being asked and if you have YES answer, please document on page

3. The less "scary" it sounds the better.


How to get it back to us for analysis

1. Scan or take photo with phone and email to me
2. Fax to our secure fax server at 919-400-4252

3. Mail to us at:  Medicare Experts, 5448 Apex Peakway, Suite 303, Apex, NC 27502

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