Permission to Contact | Price Services Group

Kayla Price — Your personal Medicare & insurance consultant

Licensed independent Medicare agent serving North Carolina and 9 other states. Complete this quick form to give me permission to reach out and help you review your Medicare options — no obligation.

Your Contact Information

First Name *

Last Name *

Email *

Phone

State *

Contact Preferences

The phone number I provided is a cell phone You have my permission to text me I am eligible for Medicare (65+ or qualifying disability) I'd like to hear about options during the Annual Enrollment Period (AEP)

Best times to reach me Morning Afternoon Evening Weekends

What Are You Interested In?

Select any that apply — this just helps me prepare. (Optional.)

Medicare Advantage (Part C / MAPD) Prescription Drug Plan (Part D) Medicare Supplement (Medigap) Dental, Vision & Hearing Hospital Indemnity

Review & Sign

By checking this box and signing below, I give Price Services Group, LLC and its licensed agent permission to contact me — including by phone call, text message (SMS/MMS), and email — at the phone number and email address I provided, regarding Medicare Advantage, Medicare Supplement, prescription drug, and other insurance plans and services. I understand these communications may be made using an automatic telephone dialing system or an artificial or prerecorded voice, that consent is not a condition of purchase, and that message and data rates may apply. I understand I can revoke this permission at any time by contacting Price Services Group, LLC, and that I may reply STOP to opt out of text messages. I confirm I have read and understand the disclosure above.

Your Signature *

Your name will appear here

✓

Thank you!

Your Permission to Contact has been recorded. Kayla will be in touch soon to help you review your Medicare options.

Schedule a Consultation

Price Services Group, LLC is a licensed independent insurance agency. We do not offer every plan available in your area. Any information we provide is limited to the plans we offer in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your State Health Insurance Program (SHIP) to get information on all of your options.

Not affiliated with or endorsed by any government agency.