Consent Forms

The Centers for Medicare and Medicaid Services (CMS) requires agents/ brokers 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.

The Centers for Medicare and Medicaid Services (CMS) requires agents/ brokers assisting consumers applying for and enrolling in Marketplace (ACA / IFP) coverage to document consumer consent prior to accessing or updating their Marketplace information. 

All information provided on this form is confidential and should be completed by each person wanting Marketplace (ACA / IFP) coverage or his/her authorized representative.