Current clients

2027 Medicare Annual Review Check-In

Name: Zaki Enterprise Tax & Insurance
Address: 14635 Beechnut St., Houston, TX, 77083, US
Telephone: (281) 741-9658

A short administrative check-in so your Zaki Enterprise advisor can prepare for the October 15 – December 7 Annual Enrollment Period. This is not an enrollment form.

Please do not send your Medicare number, Social Security number, date of birth, full medication list, or medical diagnoses through this form.

Full Name

Phone

State

ZIP Code

Current Residential Address

Street Address

Apt / Unit (optional)

City

State

ZIP Code

County

Has this address changed since your last Medicare enrollment or annual review?

Would you like Zaki Enterprise to review your Medicare coverage during the Oct. 15 – Dec. 7 Annual Enrollment Period?

Since your last review, has anything changed? (select all that apply)

Preferred appointment type

Preferred time

Contact me by (select all that apply)

Anything else we should know? (optional)

I understand this check-in does not enroll me in a Medicare plan and is not a Scope of Appointment.

Questions? Call (281) 741-9658 or (281) 827-7915. See our Privacy Policy.