I hereby give consent to KEVIN J DIAZ INSURANCE LLC, represented by Kevin J. Diaz. and/or any of its advisors, to contact me, via text message, phone calls or postal mail, for the purpose of advice regarding Medical insurance. I understand that any assistance and information is intended to provide me with the advice necessary to improve decision making regarding health insurance coverage that best suits my specific situation.

I also understand and accept that in order to provide better advice on health insurance coverage, the medical provider (meaning primary doctor and/or specialists) may require the disclosure of certain information for the process to the insurance agent, agency or its advisors, which is why I authorize the medical provider to make such disclosure in order to comply with its obligations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The medical provider or health insurance advisors will not use this information for any purpose other than advising and analyzing my insurance coverage options.

I accept that this authorization is valid as long as it is understood by both parties.