Free Medicare Consultation — Scope of Appointment

Before We Talk Medicare Plans

Federal law requires a Scope of Appointment form before any Medicare Advantage or Part D plan discussion. This form protects you — it documents what we've agreed to talk about, nothing more.

📋 What is a Scope of Appointment?

A Scope of Appointment (SOA) is a CMS-required document that outlines which Medicare topics we'll discuss during our meeting. It is not a commitment to enroll in any plan — it simply gives us the legal clearance to have an informed conversation on your terms.

⚠️ Required by Federal Law

CMS regulations require this form before any Medicare plan discussion. Completing it takes about 2 minutes and allows us to have our conversation legally and on your terms.

Betsy Barbosa Villa

Licensed Independent Medicare Broker · MA, KY & FL

📞 (508) 474-9494 — Massachusetts 📞 (502) 417-3463 — Florida & Kentucky

Scope of Appointment Form

✅ CMS-Required · Protects Your Rights · Always Free

First Name *

Last Name *

Best Phone Number *

Email Address

Your State *

Date of Birth *

Preferred Appointment Date *

Preferred Time

Topics to Discuss *
Select all that apply

Medicare Advantage (Part C)

Prescription Drug Plans (Part D)

Medicare Supplement / Medigap

Life Insurance

Dental / Vision / Hearing

Scope of Appointment Received!

Thank you, . Your form has been submitted successfully. Betsy will be in touch within 48 hours to confirm your appointment.