Fill out this form to see if you qualify:

First Name

last name

Date of Birth

state

phone

We’ll contact you to confirm insurance coverage

Insurance Information:

What is your primary health insurance?

Original Medicare

Your card should look like this

Medicare Advantage

Other insurance / I’m not sure

I don’t have health insurance

Please note

To complete your eligibility check, we will call you within the next 15 minutes. If you can’t talk now, you will be able to schedule a call on the next page.

Thank you!

What’s next?

We call you in the next 15 minutes.

One of our specialists will call you in the next 15 minutes to review your insurance info and assess Hero coverage. It will take about 10 minutes.

Look out for a call from (561) 933-6443!

Can’t talk right now?
‍
No problem!

Schedule a better time

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