Forms

Forms & Helpful Documents

Use this page to access Medicare appointment documents and helpful worksheets for prescriptions and doctors.

The official documents will be added here once uploaded. Please contact HealthPlan Haven if you need help completing any form.

If you would like to set up an in-person appointment, You can complete the SOA (Scope of Appointment) and PTC (Permission to Contact) forms and email them to greg@healthplan-haven.com, and or contact agency.

Scope of Appointment

Download and review the approved Scope of Appointment form before your appointment.

Download Scope of Appointment

Permission to Contact

Download and review the approved Permission to Contact form.

Download Permission to Contact

Client Management Form

Download and review the Client Management Form before your appointment.

Download Client Management Form

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