RX Tool

Find the Prescription Drug Plan You Deserve

Understanding and choosing from all the different types of Medicare prescription drug plans can be overwhelming. Fortunately, FHK has been helping clients find the right coverage locally for over 50 years … and health insurance is all we do! Our knowledgeable, team can confidently navigate the local marketplace and remove any uncertainty you may have around your Medicare decision.

Just take a few minutes to fill out and submit the RX Drug Plan form. Then, one of our experienced agents will personally review your information, get in touch and work to find a better plan for you. Be sure to note the agent you are working with!

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Name

Zip Code

FHK Agent

Preferred Pharmacy

Date

Phone

County

Date Of Birth

RX Info

Fill out any additional fields as necessary.

Name of Drug

Dosage (mg)

Frequency

Name of Drug #2

Dosage (mg) #2

Frequency #2

Name of Drug #3

Dosage (mg) #3

Frequency #3

Name of Drug #4

Dosage (mg) #4

Frequency #4

Name of Drug #5

Dosage (mg) #5

Frequency #5

Name of Drug #6

Dosage (mg) #6

Frequency #6

Name of Drug #7

Dosage (mg) #7

Frequency #7

Name of Drug #8

Dosage (mg) #8

Frequency #8

Name of Drug #9

Dosage (mg) #9

Frequency #9

Name of Drug #10

Dosage (mg) #10

Frequency #10

Name of Drug #11

Dosage (mg) #11

Frequency #11

Name of Drug #12

Dosage (mg) #12

Frequency #12

Name of Drug #13

Dosage (mg) #13

Frequency #13

Name of Drug #14

Dosage (mg) #14

Frequency #14

Name of Drug #15

Dosage (mg) #15

Frequency #15

Comments

Name of Primary Care Physician

Preferred Hospital System

414-228-7555

info@FHKinsurance.com

FHK Insurance
6790 N Green Bay Ave
Glendale, WI 53209

6790 N Green Bay Ave
Glendale, WI 53209

414-228-7555
info@FHKinsurance.com

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