Me and Medicare

Disclosures

Scope of Appointment (SOA)

Permission to Contact (PTC)

and other Required Dislosures

Call Recording:

For quality assurance, training, compliace purposes this call is being recorded.

Agent Information:

Name: Kent Farley

NPN: 5776547

Business Phone: (971) 366 - 2500

Email: Kent@MeAndMedicare.com

Website: www.MeAndMedicare.com

• Me & Medicare is an independent insurance agency. We are not affiliated with, endorsed by, or employed by Medicare, Medicaid, CMS, or the federal government.​​​

• We do not offer every plan available in your area. Currently, we represent [**NUMBER] organizations which offer [**NUMBER] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.

  •   The "NUMBER" of organizations and products available depends on your location. Before discussing specific Medicare plans, I will ask for your ZIP code so I can provide the applicable information for your area.

Medicare:

1-800-MEDICARE (1-800-633-4227)

TTY: 1-877-486-2048

Website: Medicare.gov

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NO OBLIGATION TO ENROLL

Talking with me does not obligate you to enroll in a Medicare plan. You should enroll only when you are ready and have decided that a plan is appropriate for your needs.

You will never be required to enroll simply because you requested information or spoke with me.

Please fill in our information:

Scope of Appointment

Please check the boxes for the topics you’d like to review. You are not required to select every option — only those you’re interested in.

This appointment will only include the plan types you have selected below

By signing this form, you agree to discuss the Medicare product types you have checked above with a licensed sales agent and consent to allow Me and Medicare LLC and Me and Senior Solutions Insurance Agency (Kent Farley), affiliated with Medicare Advocates, to contact me at the phone number and/or email I provide, for the purpose of providing information about Medicare plan options or related insurance products.  This may include automated technology such as prerecorded calls, text/SMS/MMS messages, emails, and/or AI-assisted messaging, even if my number is on a state, federal, or corporate Do Not Call list.