If you would like to request an appointment with a local, licensed agent, in Oregon or SW Washington, please fill out as much information as possible in the form below and we will contact you, usually within 48-72 business hours. Please note: During October 1 - January 1, response time may be longer.

You will also need to complete a Scope of Appointment Form so we can start the 48-hour required wait time required by Medicare to discuss plan information. (Note: Completing a Scope of Appointment Form does not give us permission to contact you. Please also complete the Request Appointment that will allow us to make contact.)