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Over 65 – Medicare Scope of Appointment

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Once you have completed the PDF, please submit it using the Submit Completed Scope of Appointment form or email your completed PDF to

Under current U.S. law, we are prohibited from contacting you about Medicare plans until 48 hours have passed following your submission of the signed Scope of Appointment form. Rest assured, a licensed agent will reach out to you once this waiting period has concluded.

Submit Completed Scope of Appointment Form

Scope of Appointment

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    Medicare Scope of Appointment

    To initiate a conversation regarding Medicare plans, please complete and submit the Medicare Scope of Appointment form, as mandated by current U.S. law. We sincerely appreciate your cooperation.

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