SeniorChoices NW
29174 SW Town Center Loop W #102
Wilsonville, OR 97070

866-682-1878
Fax: 503-682-3373

Scope of Appointment

In order for us to answer any plan specific information via a phone appointment, via email appointment, or in-person appointment, the Center for Medicare & Medicaid services requires all Medicare beneficiaries give their permission first. The attached Scope of Appointment form gives us permission to provide information on the product types you select on the form.

Signing the form does NOT obligate you to enroll in a plan, affect your current enrollment, nor enroll you in Medicare.

Please click the below link to fill out our Scope of Appointment form, to go along with your Request for More Information or Request an Appointment. This form can be filled out and faxed to us at 503-682-3373, or it can be scanned and emailed to info@seniorchoicesnw.com.

By submitting your information, a SeniorChoices NW agent may contact you by phone or email regarding your interest in Medicare Advantage, Prescription Drug, and/or Medicare Supplement plans.

Scope of Appointment Form