The following is required prior to scheduling a Medicare Appointment.

The Federal Government requires your consent for contact. By agreeing, I give my consent to be contacted by the pharmacy, any of its employees, or its vendors, including HPRx Insurance, using the contact information provided in the pharmacy's database. This may include communication regarding services, products, or other related matters. This consent does not obligate you to make a purchase, nor does it imply coverage.

The Federal Government mandates that a Scope of Appointment form be completed and submitted at least 48 hours before an agent or broker can discuss Medicare with a current or potential Medicare beneficiary. Please note, this form does not obligate you to make any purchase.

The Scope of Appointment form is located on the next page. I acknowledge that the Federal Government requires this form, and the pharmacy must obtain it from me before scheduling any appointments to remain compliant with Federal regulations.

You will have the opportunity to schedule an appointment with the pharmacy only after completing the Scope of Appointment form. Please note that you must click the "Submit" button after selecting your preferred day and time; otherwise, your appointment will not be scheduled.