Contact

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Request a guided review of medical, ancillary, and practice benefit approaches. Sending an inquiry does not select or enroll you in an option.

Benefits review request

Broker of Record authorization

Include electronic Broker of Record authorization

Selected by default for authorized practice signers. You will review the letter and confirm your electronic signature before it is sent to Gavin and to you. Uncheck the box to request a benefits review without submitting an electronic BOR.

You can also hand sign later: print the PDF from your confirmation email, sign its separate handwritten line, then fax it or arrange approved secure email delivery with Gavin. For handwritten signing without an online BOR, print a blank form and see delivery instructions.

First Name

Last Name

Email Address

Phone Number (Optional)

I am a

Primary Area of Interest

Practice Name (Optional)

State (Optional)

Number of eligible W2 employees (Optional)

Short Message (Optional)

Please do not include medical history, diagnosis information, prescription information, claim details, Social Security numbers, or other sensitive health or personal information.

Prefer email? Email Gavin directly