Top Health Cover

First Name

Last Name

Address

City

State

Zip

Phone

Email Adress

Gender

Date of Birth (MM/DD/YYYY):

Do you currently have health insurance?

Preferred Coverage Type

Household Income

I accept the terms of service below

By submitting, I provide my express written consent via this chat / webform interaction for a licensed sales agent associated with Top Health Cover and all Marketing Partners to contact me from at the number I provided, even if the phone number provided is on the National Do Not Call registry, via live, automated dialing system telephone call, text, or email. I understand this request has been initiated by me and that this is an unscheduled contact request. I understand my telephone company may impose charges on me for these contacts and i am not required to enter into this agreement as a condition of any purchase or service. I further understand that this request, initiated by me, is my affirmative consent to be contacted which is in compliance with all federal and state telemarketing and Do-Not-Call laws. Licensed Sales Agents are not connected with or endorsed by the U.S.government or the federal Medicare program. I understand I can revoke this consent at any time and consent is not required as a condition of purchase. I agree to the Privacy Policy and Terms of Service conditions.