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Disclaimer required on all forms for Medicare Beneficiaries by CMS:

According to Medicare rules, we need your permission to contact you to discuss your Medicare plan options.
By accepting this form, you are agreeing to a marketing telephone call or an email from Dawn McFarland, Licensed Sales Agent, to discuss your Medicare insurance needs. The person who will be discussing plan options with you is with or contracted by a Medicare health plan or prescription drug plan that is not the Federal Government, and they may be compensated based on your enrollment in a plan. Signing this does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage Plan, Prescription Drug Plan, or other Medicare plan.

Your submission of this form is your consent to the below:
By providing my e-mail address or telephone number, I agree to allow a licensed sales representative to call, email, and/or text me regarding information related to Medicare Advantage Plans, Prescription Drug Plans, Medicare Supplement Insurance, and/or health insurance plans, products, services and/or educational information related to health care.
You can send in your written desire to not be contacted at any time. This is a solicitation for insurance.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact or 1-800-MEDICARE to get information on all your options
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