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Health Insurance Questions

Do you currently have health coverage?
Yes
No
Are you happy with your current health coverage?
Yes
No
N/A
Do you feel as if you are paying too much for your health coverage?
Yes
No
N/A
Are you interested in a FREE quote from a private insurance company? (Not affiliated with the ACA)
Yes
No
What is your first and last name?
What is your zip code?
What is your gender?
What is your phone number?
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