Please complete this form to schedule your Medicare appointment with Loletha Shephard.
Answering these questions will serve as your Scope of Appointment (SOA) to satisfy CMS requirements.
Before meeting with a Medicare beneficiary (or their authorized representative), Medicare requires
that Sales Agents use this form to ensure your appointment focuses only on the type of plan and
products you are interested in. A separate form should be used for each Medicare beneficiary
Click
here to review definitions of the different types of Medicare plans and other health insurance products allowed during this appointment.
By signing this form, you agree to meet with Loletha Shephard to discuss the products checked below. Loletha Shephard is either employed or contracted by a Medicare plan and may be paid based on your enrollment in a plan. Loletha does not work directly for the federal government.
Signing this form does not affect your current or future enrollment in a Medicare plan, enroll you in
a Medicare plan or obligate you to enroll in a Medicare plan. All information provided on this form is confidential.