List Current Prescription Medications

You may have a printed list from your pharmacist, or an additional sheet attached.

Please do not include Over the Counter (OTC) Medication.

Name of Drug:

Strength:

Here's an example: Lipitor 10mg.

Quantity:

Frequency:

How often do you take this medication?

Do you have any questions or concerns about your coverage?

Appointment Preferences (Just for Open Enrollment Period):

No appointment needed. Please send Plan Comparison Results. I will call if I have questions. Please call me with Plan Results.

In-Person Appointments will be held at UWCA Spain Community Chest Building, 3600 8th Ave. South, Birmingham, AL. 35222.

Appointments are thirty minutes per client. Same-day in-person appointments are not available.

Please call 205-458-3330 for appointment information, changes, or cancellations.

Medicare Plan Comparison