Forms Hub

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HIPAA Notice: All forms on this page collect information in compliance with HIPAA privacy regulations. Your health information is encrypted, protected, and used solely to provide insurance guidance. We will never share your information without your explicit consent.

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Update / Change Form

Need to update your contact information, beneficiary, or plan details? Use this form to submit changes to your existing policy.

Complete Form →

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Club Medicare

Scope of Appointment (SOA)

Required by CMS before discussing Medicare Advantage or Part D plans. Complete this form before your Medicare consultation.

Complete SOA →

Club Health

Health Insurance Intake Form

Complete our intake form for individual, family, or ACA Marketplace coverage and our team will reach out with personalized options.

Complete Health Intake →

Club Life

Life Insurance Quote Request

Request a life insurance quote for term, whole, final expense, or universal life coverage.

Request Quote →

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General Contact Form

Have a question that doesn't fit neatly into one category? Send us a message and a member of our team will follow up personally.

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Newsletter Signup

Quarterly updates on Medicare, health insurance, and life insurance. No spam. Unsubscribe anytime.

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Club Medicare · Required

Scope of Appointment (SOA)

CMS regulations require a Scope of Appointment form to be completed before discussing Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plans. This form confirms the topics you'd like to discuss.

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This form is HIPAA-compliant. Your information is protected and used solely for the purpose of scheduling your Medicare consultation.

First Name *

Last Name *

Phone *

Date of Birth

By checking this box, I agree to receive customer care and account notification text messages from Hanson Insurance, LLC at the mobile number provided. Consent is not a condition of purchase. Message and data rates may apply. Message frequency varies. Text STOP to unsubscribe at any time. Text HELP for help. See our Privacy Policy and Terms of Service.

Topics you'd like to discuss (check all that apply)

Medicare Advantage (Part C) Medicare Supplement / Medigap Medicare Prescription Drug Plans (Part D) Special Needs Plans (C-SNP or D-SNP)

Preferred Appointment Date & Time

I acknowledge that completing this form authorizes Hanson Insurance to contact me to discuss the Medicare plan types I've selected above, in compliance with CMS guidelines.

Update / Change Form

Scope of Appointment (SOA)

Health Insurance Intake Form

Life Insurance Quote Request

General Contact Form

Newsletter Signup

Scope of Appointment (SOA)

Quarterly Medicare & Health Insurance Updates