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Agency Introduction with HealthSherpa AM Team
Thank you for your interest in working with the HealthSherpa Agency Account Management Team! Please take a minute to provide our team with some information about your agency. 

Note the information collected on this form is confidential, and will only be used in preparation of your introductory call.

We look forward to speaking with you!
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Email *
Agency Email Login to HealthSherpa: *
Agency Name *
Contact Name *
Contact Phone Number *
Number of Agents *
Annual ACA Enrollments *
How is your agency currently set up?
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Do all of your agents use HealthSherpa? 
Are all of your agents linked to your agency account? 
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What states do you currently sell in?
Would you like more resources on ICHRA?
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Other lines you sell
Do you have any concerns you'd like to address on the call?
How are you submitting ACA enrollments today? ( ex. healthcare.gov, other entities)
Anything else you'd like to share? 
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