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Consent Form

 

To comply with CMS guidelines effective June 18, 2023, please complete and submit this Consumer Consent Form. We need this form to search for and provide information about marketplace options and government subsidies, as well as to file or update applications.

Your privacy and compliance are our top priorities.

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Thank you for your cooperation.

Marketplace Consumer Consent Form

Follow the 2 step process for Digital Signature

Sample of the PII Consumer Consent Form

Sample

If you arrived at this page by mistake and are looking for the Medicare Scope of Appointment , please click here.

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