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At Choice Health, we take pride in helping our customers navigate a complex health care system and find affordable coverage that meets their needs.

Complete this form and provide some basic personal information to request a complimentary copy of “Your eGuide to Medicare Enrollment” that helps you understand important milestones and next steps. Then, one of our licensed Care Specialists will contact you to answer any questions and discuss your options.

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By completing this form and providing your phone number and/or email address, you consent to and agree that an authorized representative or licensed insurance agent from Choice Health LLC, its service providers, and/or affiliates may call or text (SMS) the phone number provided, or email you to answer questions, determine eligibility, provide additional information about Medicare plans offered by one or several Medicare-contracted carrier(s), and/or discuss other products and services. You are not obligated to provide your consent in order to utilize our services or make a purchase and may change your contact preferences at any time. To opt out of receiving text messages (SMS), you may reply STOP to any text message you have received. Providing your phone number and/or email address shall serve as your signature for consent with regard to such phone number and/or email address, respectively. Standard phone, data, and/or text message charges may apply from your provider. Please see the “Communications Information” link on 123medicare.com for information about text messaging (SMS), phone contact, opting out, and more.

What is your name? (first & last)

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What is your phone number

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What is your email address? (optional)

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Thank you! A Care Specialist will contact you soon.

Access a complimentary copy of “Your eGuide to Medicare Enrollment”.