Please complete this Scope of Appointment. This grants me permission to discuss Medicare options with you.
As required by Medicare, a Scope of Appointment form must be filled out before reviewing any specific Medicare plan options together.
I agree a licensed insurance agent may contact me about the products I selected by phone, text, or email. Consent is not required to purchase, and I can opt out at any time.*
Submitting this form does not enroll you in a Medicare plan. There is no obligation to make changes to your current coverage.
Your information is kept private and used only to contact you about Medicare options. We do not sell your data.
TPMO disclaimer: We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.
