Need help?

Text Me: (318) 470-2537

Call Me: (833) 773-7350

Submit a Referral to Medicare Health Connections

Fill out the brief form below and we will be in touch.

What is Your Full Name? *

What is Your Referrals Full Name? *

What is Your Referrals Phone Number? *

What is Your Referrals Email?

Has this referral given you prior permission to submit their information? *

Yes, they are aware I submitted their information

No, they are not aware that I submitted their information

By submitting this referral, I acknowledge and agree that:

I have obtained permission from the person I am referring to share their contact information with Medicare Health Connections.
Medicare Health Connections may contact me regarding this referral using the contact information I have provided.
I understand that this referral does not guarantee any services or coverage for the person referred.
Medicare Health Connections will handle all information provided in accordance with applicable privacy laws and regulations.

Copyright. Medical Health Connections. All Rights Reserved. 2024

National Producer Number for MHC: 19169797

National Producer Number for Jeremy Patterson: 8827726

Jeremy Patterson and Medicare Health Connections is NOT AFFILIATED with and Government Agency.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-Medicare or your local state health insurance program, (SHIP) to get more information on your options.

Privacy Policy & Terms of Use

(318) 470- 2537