Thank you for your interest in the Mental Health Association's Medicare Part D Information Pipeline. If you're covered by the Medicare Part D drug program and you're experiencing problems, we want to hear from you.
After reading the instructions which follow, download the form by clicking here.
***INSTRUCTIONS FOR FILLING OUT FORM***
1. Please start typing immediately after the end of each question
in the gray space provided. This space will expand as you type
your answer. Please feel free to take as much space as you need.
The cursor will automatically go to the next question when you
hit enter.
2. Send the form to us! You can do any of the following:
| A | Print form, fill out, and fax to 1-248-647-1732 |
| B |
Print form, fill out, and mail to: Mental Health Association in Michigan 30233 Southfield Road, Suite 220 Southfield, MI 48076 |
| C |
Save as document, fill out on your computer
using Microsoft Word, and send as an attachment to partdmha@aol.com |
| D | Send an e-mail message (without an attachment) that provides us as much of the requested information as possible and email it to partdmha@aol.com |