About Us

We are passionate about changing people’s lives and protecting them from financial catastrophe due to unforeseen illness and death. We have a responsibility to always educate, and to make recommendations based on YOUR needs-never sacrificing integrity for our own gain.

We offer top solutions shopped from an open market in the areas of Medicare, Health, Life and Retirement Planning. Retire on Your Terms!

Service Areas

  • Maple Grove, Minnesota
  • Minneapolis, Minnesota
  • St. Paul, Minnesota
  • Rochester, Minnesota
  • Duluth, Minnesota
  • Bloomington, Minnesota
  • Brooklyn Park, Minnesota
  • Plymouth, Minnesota
  • All of Minnesota

612-424-0505 OR gretchen@serenityha.com


By calling the number above, or emailing the address listed, you will be connected with a licensed insurance agent.

Scope of Appointment

Serenity Health Advisors Logo

Scope of Appointment Confirmation Form

The Centers for Medicare and Medicaid Services require agents to document the scope of a marketing appointment prior to any face-to-face sales meeting for ensuring understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential.

Products

Please check the product(s) below that you want the agent to discuss.




By completing this form, you are agreeing to a meeting with a sales agent to discuss the types of products you specified above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan.

Completing this form does NOT obligate you to enroll in a plan, affect your current enrollment, or enroll you in a Medicare plan.

Authorized Representative

Are you an authorized representative with power of attorney acting on behalf of the beneficiary?
Please note: if you do not have power of attorney and act as an authorized representative, this scope will not be accepted.

Beneficiary

First Name
Last Name
Street Address
Street Address (line two)
City
State
Zip Code
Phone Number

Date of Meeting

Signature

I understand this is a legal representation of my signature.


By clicking "Submit", I have read and understand the contents of the Scope of Appointment form, and that I confirm that the information I have provided is accurate. If submitted by an authorized individual (as described above), this submission certifies that 1) this person is authorized under State law to complete the Scope of Appointment form, and 2) documentation of this authority is available upon request by Medicare.