• Medicare Advantage Questionnaire

  • *You are not required to provide any private, protected health information (PHI). The below requested information is for use by Mark E. Werner, MSFS, CFP, RICP, RICP, CLU, ChFC only to help you make an informed plan decision and will not be shared with any third party.

    You will be providing the PHI voluntarily and without coercion from Mark E. Werner, MSFS, CFP, RICP, CLU, ChFC.*

  • If you already filled out your Medicare Part D Questionnaire, you may skip down to the questions about your Doctors. 

  • Should be Empty: