About Team Partners FAQ

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Please fill out the form below to find out if you qualify for our program.

Personal Information

First Name*

Last Name*

Phone Number*

Email*

State*

Insurance Information

Do you have health insurance?*

Yes

No

Do you have Original Medicare as your primary health insurance?

Yes

No

Do you have secondary insurance, such as a Medicare supplement?

Yes

No

If you know it, what is the name of your secondary insurance company. If you don’t know, you can skip this question.

Do you have Medicare Advantage?

Yes

No

What insurance company do you have your Medicare Advantage plan through?

What insurance company do you have your coverage through?

Medical Information

Do you have any of the following conditions?*

Diabetes

Hypertension

Obesity

High cholesterol

Heart disease

Other

Thank you!
‍
One of our Patient Educators will give you a call within the next 24 hours.

From there, we’ll get to know you, review your eligibility, answer any questions you might have, and help you get signed up.

We look forward to talking to you by phone soon — have a great day!

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