- Affiliate Agents -

First Name:

Last Name:

Birthdate:

Address:

City:

State:

ZIP Code:

Telephone#:

E-Mail Address:

Contact By:

Telephone E-Mail

Agency Name:

Products:

Annuities
Cancer
Health
Final
Life

LongTerm
MedSup
Mortgage
Trusts

We sincerely appreciate your interest in our company, and would like you to consider
joining the winning American Diabetes Management agent/broker team.

American Diabetes Management is a plan designed for individuals who, by doctors orders, are required to check their blood glucose level.

American Diabetes Management is committed to your success in representing our company. We value and consider each agent/broker an important component of our company. You will find American Diabetes Management very different from most companies you have done business with. We designed the contracting phase with the Agent in mind. Our company is an ease to do business with. You can be contracted and be ready to enroll your first Member within minutes.

You have the American Diabetes Management team behind you, so ask questions anytime you need; we are here for you, The Agent / Broker.

DISCLAIMER: American Diabetes Management is not a Medicare Advantage Special Needs Plan. American Diabetes Management is not contracted or affiliated with The United States Federal Government or The Centers for Medicare Medicaid Services.