Medicare Check-up Form

By submitting this form, you understand that, and give permission to, a licensed agent to contact you.

"*" indicates required fields

Your Name*

Phone Number*

Your Email*

Date of Birth*

Zip code*

What is your Preferred Hospital?

What town is your Preferred Hospital in?

What is your Preferred Pharmacy?

Are you open to having your prescriptions mailed to you, if it saves you additional money?

Yes

Medication List (Click "+" to Add More)

Drug Name

Dosage (MG Amount)

Times Per Day

Form of Medication (Tablet, Capsule, Liquid, etc.)

How Often Refilled? (Daily, Weekly, etc.)

Doctors (Click "+" to Add More)

First Name

Last Name

Speciality

City

Zipcode

Current Plan(s) / Comments / Additional Drugs or Doctors

By submitting this form, you understand that, and give permission to, a licensed agent to contact you.

Additionally, you agree to the following: “I have voluntarily provided the health information on this sheet to Senior Benefits And Beyond to aid in the choice of an individual/group health plan. I am pursuing their advice for a Medicare plan that will best serve my needs. I agree to receive my personal no cost, no obligation recommendation and I further authorize Robin Tefft to contact me by phone or mail, if needed. This information, provided to Senior Benefits And Beyond on this form, is not to be used for any purpose other than for my Medicare health plan selection. I understand I am not bound to accept their recommendation. By signing below, I am authorizing a licensed agent from Senior Benefits And Beyond to contact me regarding my healthcare needs.”

Robin is exceptionally well-prepared, knowledgeable and detail-oriented in deciphering the different Medicare Supplement programs to enable me to choose the right program for my particular needs. Her clear communication and helpful demeanor mean the world to me.

Daria C.

Robin listened carefully to understand my needs, then presented a few plans that would fit my needs. She answered questions and helped me to understand the options. Robin made this a much less stressful process. Robin, thank you for your help.

Nancy W.

Robin streamlined everything having to do with Medicare Advantage plans. I told her what I wanted and she found the perfect plan. Most people find it daunting. I wouldn't work with anyone else and neither should you.

Lisa S.

If you are retiring and need to get your healthcare Medigap insurance in order, CALL ROBIN!! She was fantastic. She had the answer to almost every question (she looked the one she didn't have), listened to all our concerns before suggesting plans and options, and tailored health insurance for out needs. She know exactly what we needed to do now to avoid problems down the line. And she did it graciously and with a smile. I know I bugged her a bunch of times with questions and concerns, but she always answered with a smile and answered promptly - one answer came on a weekend.She's calm, engaging, and made us feel secure in our options. She gave us choices based coverage geared to what would save us the most money with the best coverage, and explained why she chose the. She didn't just push us to the lowest or highest insurance companies. And she did all this in 2 weeks.If you need help navigating Medigap plans. Call Robin.Oh, and by the way, after you pick you plans, gets set up with the companies and have your insurance cards in hand, Robin doesn't go away. She's there to answer questions afterwards. She cares for her clients and it shows.We were fortunate to have been given her contact info. And I would not hesitate to, and plan to passer her contact information to anyone I know who needs Medigap plans.Thank you Robin!!

Lonn B

Robin has been such a pleasure to work with prior to, during and after the Medicare sign-up process. She is such a down-to-earth human being and really has a passion for what she does. The services she provides are truly personal to each person's specific needs and desires. I highly recommend if you're even a year away from your 65th birthday, give Robin a hollar and get your education started. Trust me, time flies! There's a lot to learn and Robin will hold your hand all the way!

Bree W.

Robin provided all the information needed relative to my application for Medicare Supplement plans. She responded quickly and effectively to questions. She made herself available for in-person meetings, processed the applications, and immediately let me know when everything was approved.

Selma G.

renee E.

Robin is dependable, knowledgeable, and a total pleasure to work with. A true friend of seniors who are confused about the Medicare retiree insurance options.

karen L.

Robin made my transition to Medicare seamless. I am thrilled with the plan she recommended!

Martha D.

Inbisat S.

Laurie E.

Robin Tefft (FJDTech T.

84 Main Blvd
Ewing, NJ 08618

“We do not offer every plan available in your area. Currently, we represent 8 organizations that offer 61 products in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. This is a proprietary website and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program please visit the Official U.S. Government Site for People with Medicare located at http://www.medicare.gov”