Intake Forms

If you have a potential crisis Medicaid case, use one of our intake forms to gather and organize your client’s case facts. When you’re ready, e-mail the form to us at [email protected] for a complimentary analysis of your client’s situation.

• Single Person
• Married Couple
• Married Couple – Both Institutionalized
• Simple Quote Form for Medicaid
• Immediate Annuity/PSK Quote Form
• Long-Term Care Insurance Intake Form
• Tax-Deferred Annuity Quote Form