Schedule A Free Consultation

Your Healthcare Made Easy

Step 1.

Complete the scope of appointment form below. 

Step 2.

Once you submit the form, you will be prompted to schedule a call with an agent.

Step 3.

Speak with an agent at no cost and learn about what options are best for you!

Please complete the below and after submission, you will be redirected to our online calendar to schedule your complimentary consultation. All information is confidential. Please be advised that per the CMS & Medicare regulations, it is required to get a Scope of Appointment 48hrs prior to an appointment date.

Scope of Appointment Form

    Before meeting with a Medicare beneficiary (or their authorized representative), Medicare requires that Licensed Sales Representatives use this form to ensure your appointment focuses only on the type of plan and products you are interested in. A separate form should be used for each Medicare beneficiary.

    The licensed Sales Representative will go over the below health products:

    By signing this form, you agree to meet with a Licensed Sales Representative to discuss the products checked above. The Licensed Sales Representative is either employed or contracted by a Medicare plan and may be paid based on your enrollment in a plan. They do NOT work directly for the federal government.

    Signing this form does NOT affect your current or future enrollment in a Medicare plan, enroll you in a Medicare plan or obligate you to enroll in a Medicare plan. All information provided on this form is confidential.

    Beneficiary or Authorized Representative Signature and Signature Date:

    Your Name :
    Your Email :
    on

    Get the best healthcare consultant by contacting us.

    Medicare Supplement Insurance

    6551 S Revere Parkway

    Suite 290

    Centennial, Colorado 80111