Scope of Appointment

This document allows me to discuss various Medicare products with you.

• Click in the box next to I am not a robot. This will take you to the SoA page.
• Please indicate the type of product(s) you want the agent to discuss:  If unsure, leave all four checked, otherwise, check your preference(s).  
• Beneficiary Details: You are the beneficiary. Fill in the boxes accordingly.
• Meeting Preferences: It does not matter what you put in here. (Please note that if you have not previously discussed an appointment time/date, putting it in those fields does not create an appointment. You must reach out to an Aaron Flake Health Agency representative to make an appointment.) 
• Beneficiary/Authorized Representative Signature and Signature Date: Sign with your mouse or finger.
• Click the yellow submit & download button.