SHIBA Contact Form

Please SELECT ONE (1) of the options from the dropdown menu.

Please enter your FULL NAME (first & last) by which you prefer to be addressed.

Please enter the CITY and ZIP CODE associated with your / the beneficiary's residential address.

Please SELECT ONE (1) of the options listed below:

Please enter the email address you would prefer us to contact you or send materials.

Please enter the PHONE NUMBER you prefer for us to call to reach you.

If "YES", please make sure the voicemail inbox is properly set up & empty enough to receive new messages.

For Medicare beneficiaries who are eligible to do so, setting up one's Medicare.gov account is highly recommended. Having access to it during a SHIBA counseling session saves much time for both the beneficiary & their advisor.

Please SELECT ONE (1) of the options from the dropdown menu.

Please provide any additional relevant information or briefly summarize your needs. (Maximum 300 characters)

This field is for validation purposes and should be left unchanged.

SHIBA Contact Request