Open Enrollment Health Insurance Virtual Appointments
Thank you for taking the time to register for health insurance during the Open Enrollment period (Nov 1 - Jan 31). This form will help you schedule a one hour appointment with a certified assistance counselor. All appointments will take place via Zoom. Tuesday appointments are offered between 10 AM and 1 PM. Wednesday appointments are offered between 5 PM and 8 PM.
First & Last Name *
Please share your email address (to join the Zoom meeting via your computer or other device) or phone number (to join the Zoom meeting via phone call): *
Which day would you like to schedule an appointment? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy