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 NameLast Name

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

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 and agree that by submitting this form, a licensed insurance agent affiliated with MedicareCompareUSA may contact me via phone, email, or text (including calls/texts placed with an autodialer), and that I am under no obligation to purchase insurance. This consent is not a condition of purchase.*

Yes I have read and understand the terms and conditions

Enter the message as it's shown*

MedicareCompareUSA is an independent health insurance agency not affiliated with the federal Medicare program. All services are provided at no cost and without obligation; MedicareCompareUSA and affiliated agents are paid directly by the Medicare plan when enrollment occurs. Healthcare providers receive no financial benefit when patients use the service. We do not offer every plan available in your area. Currently we represent 6 organizations which offer 24 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.