ReDiscover Insurance

Doctor and Prescription Form


Please provide an address for each physician to ensure doctors are within network. For example:
1.  Dr. John Smith: 80th and Wadsworth
2. Dr. Jane Smith: University and Quebec
Please list each prescription you take
For example:
1.  Atorvastatin 10mg 2x/day
2. Levothyroxine 10mg 1x/day

ReDiscover Insurance is an independent licensed insurance agency and is not affiliated with or endorsed by the government or the federal Medicare program. Insurance-related solicitation. We do not offer every plan available in your area. Currently we represent 8 organizations which offer 1-100 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.

  • This is a solicitation for insurance.

  • Calls are for marketing purposes.

  • Cellular carrier charges may apply.

  • Providing permission does not impact eligibility to enroll or the provision of services.

  • You can change permission preferences at any time by contacting 720-722-0589.

Thanks for filling out the form!