Order Materials and Tools

The materials and tools listed below are specialty items, which inform Medicare beneficiaries and their families about Medicare rights and senior health issues. These items are available for order, free of charge, using this order form. Please note that these items may be in short supply - we will contact you if we cannot fulfill your order.

1. Note the number of each item you would like to order in the [Qty.] box next to the item
2. Fill out your contact information at the bottom of this form
3. Click the [Send Order] button