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Consent to Contact Form

For Renata Lahner or Jeff Harder

Our independent Insurance Advisors are a great resource to

help you learn the basics of Medicare or explore the plans

available to you. We’ll get you all the information you need to

make confident decisions about your coverage.

And, as always, there is no cost or obligation to you for their

assistance.

Medicare regulations require that we obtain your consent

before we contact you to discuss Medicare Advantage plan(s).

PLEASE NOTE: This Consent to Contact Form is optional.

Submitting this optional form does NOT obligate you to enroll in

a plan, affect your current or future Medicare enrollment, or

automatically enroll you in a plan.

By completing this form, your information will be provided to a

licensed insurance agent. You may be contacted by a licensed

insurance agent. To contact an Independent Agent Call

(207) 706-6477

Not affiliated with or endorsed by

Medicare or any government agency.