Scope of Appointment
The Centers for Medicare and Medicaid Services requires agents to document the scope of a marketing appointment prior to any sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and should be completed by each person with Medicare or his/her authorized representative.
By completing and submitting this form, you agree to a meeting (in-person or over the phone) with me, Michael Randall, to discuss the products you indicate below. I am contracted by the health plans we will discuss, and I do not work directly for the federal government. I may be compensated based on your enrollment in a plan.
Signing this form does NOT obligate you to enroll in a plan, affect your current enrollment, or automatically enroll you in a plan.
Clicking “SUBMIT” at the bottom of this form serves as your electronic signature for this form only.