FORMS

For Medicare Clients

ACA Healthcare Enrollment Form (Under 65)

SOA - Scope of Appointment

This form is Mandatory before a license agent can speak to you about any specifics about Medicare Advantage and PDP plans.

SOA FORM

ACA Healthcare Enrollment Form (Under 65)

New clients, please fill out this form prior to your appointment. New governmental requirements that must be confirmed and verified when an agent is assisting clients for healthcare.

Enrollment form

SMS Consent Form

ACA Healthcare Enrollment Form (Under 65)

ACA Consent Form

Consent to receive text messages from LS-Insurance due to government regulations.

SMS Consent Form

ACA Consent Form

Life Insurance Questionnaire

ACA Consent Form

This form is for current clients only. Starting this year 2023 the States as well as the Federal Government is requiring that we have to have a written permission in order to serve you.

Consent form

For Medicare Clients

Life Insurance Questionnaire

NEW Medicare Beneficiaries, this form is a Medicare Assessment, so I have an understanding as to how I can help you in selecting the Best plan to meet your Healthcare needs.

Assessment form

Life Insurance Questionnaire

This form is for clients who wants a quote and has set an appointment to discuss their options for a Life Insurance policy or other alternatives.

Life Insurance Form

ACA Self-Employment Affidavit

This form is for those enrolling in a healthcare plan on the Exchange. This form is all you need to show proof of income. Your income is Revenue minus your Expenses.

ACA Self-Employment Affidavit

Home and Auto Quote Form

ACA Self-Employment Affidavit

This form is for home and auto insurance. Let us help you get the best price for all your home and auto needs.

Home and Auto Quote Form

Commercial Insurance Form

ACA Self-Employment Affidavit

Workers Compensation Insurance Form

This form is for business owners looking to shield your business from unforeseen risks and potential financial setbacks with our comprehensive commercial insurance solutions.

Commercial Insurance Form

Workers Compensation Insurance Form

This form is for business owners in need of workers compensation insurance.This insurance is designed to provide financial security and peace of mind in the event of work-related injuries or illnesses.

Workers Compensation Insurance Form

Daycare Insurance Form

Workers Compensation Insurance Form

Malpractice Insurance Form

This form is for daycare owners in need of insurance. This insurance provides daycare owners with the liability coverage as well as business property coverage.

Daycare Insurance Form

Malpractice Insurance Form

Workers Compensation Insurance Form

Malpractice Insurance Form

This form is for healthcare professionals in need of malpractice insurance for their practice or healthcare center.

Malpractice Insurance Form

LS-insurance

LS-INSURANCE FORMS

Instructions

For Medicare Clients

ACA Healthcare Enrollment Form (Under 65)

ACA Healthcare Enrollment Form (Under 65)

ACA Healthcare Enrollment Form (Under 65)

ACA Healthcare Enrollment Form (Under 65)

ACA Healthcare Enrollment Form (Under 65)

SMS Consent Form

ACA Healthcare Enrollment Form (Under 65)

ACA Consent Form

ACA Consent Form

Life Insurance Questionnaire

ACA Consent Form

For Medicare Clients

Life Insurance Questionnaire

Life Insurance Questionnaire

Life Insurance Questionnaire

Life Insurance Questionnaire

Life Insurance Questionnaire

ACA Self-Employment Affidavit

ACA Self-Employment Affidavit

ACA Self-Employment Affidavit

Home and Auto Quote Form

ACA Self-Employment Affidavit

ACA Self-Employment Affidavit

Commercial Insurance Form

ACA Self-Employment Affidavit

Workers Compensation Insurance Form

Workers Compensation Insurance Form

Workers Compensation Insurance Form

Workers Compensation Insurance Form

Daycare Insurance Form

Workers Compensation Insurance Form

Malpractice Insurance Form

Malpractice Insurance Form

Workers Compensation Insurance Form

Malpractice Insurance Form

Psychiatrist Malpractice Insurance Form

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