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FORMS

Please email completed forms to

inquiries@integritybrokers.org

Signature

Scope of Appointment

A Scope of Appointment (SOA) form is required by CMS to be signed by both the agent and beneficiary prior to your appointment. It is to ensure that no other products are discussed outside of what the beneficiary originally requested. This protects the beneficiary from being enrolled in products they never wanted to be enrolled on.

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Medicare Account Creation Authorization

Your Medicare account contains the most up-to-date information regarding your insurance including your prescriptions and plan information. By signing this form and giving Integrity Insurance Solutions access to your Medicare account, you are allowing us to access your most current insurance information.

Fill out your authorization form here

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