Please take a moment to fill out this brief survey to help ensure that we are providing valuable programs to our community.

By completing the survey you help us to continue to offer these programs at no cost to you.

"*" indicates required fields

(MM/DD/YYYY)
MM slash DD slash YYYY
(MM/DD/YYYY)
MM slash DD slash YYYY
Hidden
Name
Hidden
How would you rate your overall knowledge of Medicare? * Required
How would you rate your understanding of what the various parts of Medicare cover? * Required
How would you rate your understanding of the costs associated with Medicare enrollment? * Required
How would you rate your knowledge of how to access resources to help with Medicare planning and questions? * Required
How would you rate your confidence in choosing a Medicare plan that works for you? * Required
We would like to follow up with you in 30-45 days after your participation in this program. * Required
Remember that your approval helps us to ensure that our programs are of value to our community.