"*" indicates required fields Medicare Solutions Contact Request Please call the Medicare hotline directly at 1.888.825.0223 for immediate inquiries. Note that GoldenCare USA will attempt to reach your referral three times by phone, then the lead will be contacted by email (with you included on the correspondence). If after three attempts the client is unresponsive, a new request must be submitted with the prospect's permission.Referring Agent/Advisor Contact Information Please input your name and contact information for tracking purposes.Has the required consumer piece "Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare" been distributed to the client?* Yes No Referring Financial Advisor* First Last Referring Financial Advisor Phone Number*Referring Financial Advisor Email* Who is the client/prospect requesting information? Inquiries will be responded-to within 2 business days.Client/Prospect Name* First Last Sex* Male Female Birthdate* MM slash DD slash YYYY Client/Prospect Email* Resident Zip Code* ZIP Code Client/Prospect Phone Number*Best time to call* Mornings (8 am to 12 pm) Afternoons (12 pm to 4 pm) Is there an accompanying request for a spouse/partner?* Yes No Please note that a separate request must be submitted for spouse / partner.
