Welcome to ACA 101: Your Guide to

Understanding ACA

Navigating ACA can be complex, but we're here to help. Our comprehensive 'ACA 101' presentation will provide you with the essential information you need to make informed decisions about your healthcare coverage.

Ready to take the next step?

Simply fill out as much of the info below as you feel comfortable (some fields are required) and click the "Submit" button. What happens next is you will receive a welcome email and text prompting you to schedule a phone appointment with me. If you prefer email communication only, please note that in the "additional info" field below.

Health Insurance Intake Form

First Name *

Last Name *

Phone *

Email *

State

Postal code *

County?

What is your date of birth? *

Are you a Tobacco User? *

Additional date(s) of birth for Spouse and/or Dependents

Estimated 2025 household income? (used to calculate financial assisatnce)

Current health insurance plan info?

What are the most important characteristics and benefits you would like included in your new health coverage?

Current doctors?

Current prescription needs?

Are you interested in dental and/or vision coverage?

Additional info?

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Welcome to ACA 101: Your Guide to

Understanding ACA

Navigating ACA can be complex, but we're here to help. Our comprehensive 'ACA 101' presentation will provide you with the essential information you need to make informed decisions about your healthcare coverage.

Ready to take the next step?

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