Permission to Contact

Grant Permission to Contact & Call

Before we can schedule your consultation, we need your permission to reach out. Complete the form below, and we'll take you straight to the consultation calendar.

We're licensed in Oklahoma, Mississippi, and New Mexico only. You must live in one of these states to schedule a consultation. Please confirm your state of residence in the form.

Your details & consent

Permission to Contact is required. Before we can schedule your consultation, please provide your contact details and consent below.

We're licensed to consult in Oklahoma, Mississippi, and New Mexico only. To schedule a consultation, you must reside in one of these states. If you live elsewhere, we're unable to book a consultation at this time.

First name *

Last name *

State of residence *

Email *

Phone *

Your Medicare status

Reason for consultation

Best time to contact you

Consent

I give permission to be contacted by phone by Simply Live Your Life Medicare and Beyond regarding Medicare products and services. (Required)I agree to receive email communications. Unsubscribe anytime.

Educational notice: This website provides general Medicare information for educational purposes only. It does not guarantee any savings, benefits, or coverage, and is not a substitute for personalized advice. We do not represent that any specific beneficiary will receive the same benefits. For individualized guidance, request a consultation.

Why we need this

We may only contact you about Medicare products and services after you've given us explicit permission. This form records your consent so we can legally call or message you — and so your consultation can actually happen.

Required before booking a consultation
You can revoke consent at any time
We never sell your information

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