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EXISTING CUSTOMERS - use this form to update your phone, email, or address changes.

NEW CUSTOMERS - use this form to add your basic data to our system for a return call or email.

(Vendors using this form to solicit goods or services will be prohibited from future business with us.)

 

Our agency does NOT have a storefront office - all appointments are in your home, public space, by phone, or in a virtual setting. All medications and appointment cards are requested to be available prior to, or at, our meeting to conduct a thorough needs analysis. Further, CMS requires a completed Scope of Appoinment form 48 hours prior to any discussion of plan specific information. 

 

‘‘I understand that the person who will be discussing plan options with me is a licensed and certified agent; they will be compensated by the carrier if I choose to enroll. Our agency represents 12 carriers offering approximately 500  MAPD and 14 PDP plans, in those states. . Please contact Medicare.gov or 1800MEDICARE or your State Health Insurance Program (SHIP) office, to get information on all of your options.’’ 
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