OFC Clinic - Healthcare Consultation Request Form

MedicareCompareUSA agents are ready to help you review Medicare insurance plan options and enroll in one accepted by OFC Clinic.

Please fill out the form below, and a MedicareCompareUSA representative will contact you to schedule your private appointment.

Full Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

Please choose your preferred Emory Healthcare Consultation location - Select one below: *

Please check box if you are not currently on Medicare but will soon become eligible for Medicare

Not currently on Medicare

Do you have any specific questions for us?

Terms and Conditions

I understand that by submitting this request, a MedicareCompareUSA representative or agent will contact me to schedule a Medicare Insurance Consultation. I understand that I am under no obligation to purchase insurance. Should I apply for a Medicare plan using the services of MedicareCompareUSA, I understand that the agent will be compensated directly by the Medicare plan I choose. Consultations require an advance appointment. *

Yes I have read and understand the terms and conditions

Enter the message as it's shown *

MedicareCompareUSA is an independent insurance agency not affiliated with the federal Medicare program. Services of MedicareCompareUSA are provided at no cost; MedicareCompareUSA and agent are paid directly by the Medicare plan chosen by the Medicare beneficiary when enrollment occurs.