Request Medicare kits

Fields with an asterisk (*) are required and must be filled out to process your request.

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How many of each kit would you like to order?

When you submit this information to Fallon Health, the transmission will be sent using encryption security. However, to protect your privacy, please do not use email to communicate information you consider confidential, including medical information, clinical questions, or concerns about your care or treatment. If you have clinical questions or concerns about your treatment, please speak with your primary care provider or call a customer service representative at 1-800-868-5200 (TRS 711).