Medicare Scope of Appointment — LIOR Agency, LLC

Before your appointment, please select the types of coverage you would like to discuss with a licensed insurance agent. Choose only the topics that interest you. Completing this form does not enroll you in insurance.

Your Agreement

By signing below, I agree to an appointment with a licensed insurance agent from LIOR Agency, LLC to discuss only the coverage types I selected.

I understand that:

• I am under no obligation to enroll in or purchase a plan.

• Completing this form will not automatically enroll me in a plan.

• My current or future Medicare enrollment status will not be affected.

• If I request discussion of another coverage type, an additional Scope of Appointment will be documented before that discussion.

We will send you an email of the date and time of your appointment with an LIOR agent's name and NPN number.