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Medicare Scope of Agreement

This form must be completed and signed prior to an appointment to ensure 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 and should be completed by each person who has Medicare or their authorized representative.

Member of American Agency Insurance Group


Member of The Blue Chip Consortium L.L.C.

Chas. W. DeWitt Insurance Agency, Inc.
390 S. Woods Mill Rd. Ste., 100
Chesterfield, MO 63017
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Hours of Operation:

Mon-Fri: 8:00am-5:00pm
Saturday - By appointment
Sunday - Closed

 



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