Daily Staffing Tracker & Disposition Report
Use this form to quickly report your daily activity at all MedicarePrepare staffing events and locations (Offices, Crest, Walmart, Clinics or other retail locations) AND to report your sales. You can also use this Secure Upload Link to upload your Paper apps to us (we will send them to the carriers for you). Please complete this each day your are staffing OR anytime you complete and enrollment.
Agent Name
*
First Name
Last Name
Crest Locations:
Crest Moore
Crest MWC on Douglas
Crest Norman
Crest Edmond near I-35
Crest Edmond HQ store
Crest MWC on Reno
Crest Yukon
Crest on South May Ave
Crest on 23rd Street
Crest on Rockwell
Walmart locations:
Walmart Sapulpa
Walmart Claremore
Walmart Kenosha & 145th
Walmart BA Hillside
Walmart Muskogee
Walmart Keller, Tx
Walmart Springdale, AR
Clinic Locations:
St Francis Heart Hospital
St Francis Health Zone
Warren Clinic at 106th & Memorial
Other
Office Locations:
Tulsa Timberline
Tulsa Bernsen
Tulsa EastGate
Tulsa Broken Arrow
OKC Quail Springs Mall
Date staffed this location:
-
Month
-
Day
Year
Date
How many Medicare conversations did you have?
How many appointments did you book today?
How many enrollments did you make today?
Which Carrier/s?
Blue Cross
UHC
Humana
Globalhealth
CCOK
Devoted
Aetna
Wellcare
Other
Which Carrier's?
TruAssure
Manhattan
American Amicable
Cigna
Other
Have you already sent this app to the carrier? (Only need to answer this if you send in a paper app on this form, otherwise leave it unchecked).
No, I have not
Yes, I have
Secure Upload Link (send your paper apps here):
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