CMS-Required Scope of Appointment Disclosure: In compliance with the Centers for Medicare & Medicaid Services (CMS) guidelines, we are required to document the topics you wish to discuss before our appointment. This helps ensure our meeting focuses on your specific needs. The following products may be discussed: Medicare Advantage Plans (Part C), Medicare Prescription Drug Plans (Part D), Medicare Supplement (Medigap) policies, and related ancillary products.

I acknowledge and agree to this Scope of Appointment. I understand that by checking this box, I am providing my consent to discuss the Medicare plan options selected above with a licensed insurance agent. This does not obligate me to enroll in any plan.