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forms

If you need the Medicare Part B Application and/or the Request for Employment forms, please give us a call 1-800-330-8445, or email us at info@valeryagency.com. We will be happy to send you the forms, along with step-by-step instructions on how to submit them to Social Security.

For a review of your drug plan during Annual Enrollment, please download both forms below. Once you fill them out, save the completed forms to your desktop & email them as attachments to info@valeryagency.com

Prescription Drug List

Scope of Appointment

Annual Enrollment for Rx plans is

October 15th to December 7th

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