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Please fill out the client intake form. This will enable us to guide you through your Medicare options and ensure you get the coverage that best meets your needs

Tips for completing this form
You must click the blue 'Continue' button at the bottom prior to being able to complete the form. 
Once you have completed the form, click the 'Submit' button at the bottom. You will be prompted to input your name and email address.
You will receive a verification email from Adobe. Once you verify, Affinity and yourself will receive a copy of the completed form.
Once we have received the form, your Guru will reach out to schedule an appointment.
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