CONSENT FORM

LATINOS HEALTHCARE 2026

Full Name *

Date of birth *

Authorize Tourism Telecommunications Bureau Corp, d/b/a Latinos Healthare, and David Gomez to review my healthplan for me and/or my family in the CMS Health Marketplace

Renew the same plan I have but reduce my cost from auto-renew

I want to change my plan for 2026, Give me options please

I do not have a health plan. I want to apply, please assist me

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By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested above. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

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