Brokers & Agents

Partnering with MaxHealth is easier than ever

Our broker, agent, and Medicare advisor partners are a core part of each patient’s team. At MaxHealth, our goal is to simplify the entire healthcare experience for both you and your clients. We work directly with your clients to answer any questions they have and ensure a seamless, easy experience, no matter their health situation.

Register your Medicare-eligible clients

Complete this form so our Patient Advocate team can help schedule your client’s appointment.

"*" indicates required fields

FMO / Brokerage / Health Plan*

NPN

Your First Name*

Your Last Name*

Your Phone*

Your Email*

Patient's Member ID

Patient's First Name*

Patient's Last Name*

Patient’s Phone Number*

Patient’s Email*

Patient's Date of Birth*

Patient's Gender*

Patient Type*

Patient's Health Plan*

Patient Effective Date*

Provider Assigned*

Clinic Location*

Message

Name

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

New Patient Package

After completing the registration form, provide the patient with the New Patient Package and coordinate its completion.

Questions or need assistance enrolling your client?

Patient Advocate
(727) 316-6914

maxsocial@mymaxdoc.com

Interested in the broker program?

Kylie Glisson
Business Development Director

kylie.glisson@mymaxdoc.com

Resources

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Provider Participation ID's

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