Medicare Insurance Benefits New Client Survey

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Our goal is to provide professional, unbiased advice that helps you choose the right Medicare Insurance plan for your specific needs. In order to improve every day towards our goal, we need the help of our new clients.

If you will take just a minute to complete this survey, it would truly help us better. Also, just as a way of saying thank you for your time, we draw one name from our surveys each month for a Visa Gift Card.

New Client Survey: We value you input and share this with our agent so that we can improve every day.

Name *

First

Last

Email *

Did your agent answer all questions effectively and politely? *

Yes No

Were you provided our toll free client sevice phone number? *

Yes No

Do you fully understand your basic Medicare benefits? (what is provided by parts A and B) *

Yes No Some, but not all

Do you fully understand your benefits provided by the Medigap or Medicare Advantage plan you selected? *

Yes No Some, but not all

On a scale of 1 to 5, how likely are you to refer your agent to a friend or family member? *

Additional Comments or Testimonial *

May we use your testimonial and first name in correspondence with future clients? *

Yes No

Would you like your agent to send you information about our dental or life insurance plans? *

Yes - Dental Yes - Life Yes - Both No Thanks

Submit

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