2023 Open Enrollment Update Form

Please complete this form to help me know how to best assist you during this year's Open Enrollment. If you have any questions feel free to reach out.

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How to Connect with Me

1. The simplest way to get help from me is to schedule a time on my calendar below.

It can be a paint to find a time when we are both free. That's why I have a calendar where you can pick a time that works best for you, and you know I'll be free too!


2. Send me a message. You can use the form below to send me a message or send me a text at 317-505-1705.


3. Give me an old fashioned phone call. This is a busy time of the year when I have a lot of appointments, so if I can't answer, just leave me a message and I'll get back to you by the end of the day. My number is 317-505-1705

I expressly consent to receive emails and phone calls via automatic telephone dialing system or by artificial/re-recorded message, or by text message from licensed sales agents of Medicare Indy, affiliates, partner companies and their partners at the telephone number above, including my wireless number if provided, message and data rates may apply. I understand that my consent to receive communications in this way is not required as a condition of purchasing any good or services. If you are Medicare-eligible, a licensed sales agent will contact you about Medicare, a licensed sales agent will contact you about Medicare plans by phone or email. Submitting this form does NOT affect your current Medicare Part A and Part B enrollment, nor will it enroll you in a Medicare Advantage Plan, Prescription Drug Plan, Medicare Supplement plan or other Medicare plan. I acknowledge that I have read and understand the Privacy Policy of this site and agree to be bound by it.  

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov [http://medicare.gov/] or 1–800 MEDICARE to get information on all of your options.  

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