SunriseHealth Enrollment
ENES(305) 555-0148

May we call you?

This is a separate permission from the one you just signed. That one lets an agent work on your Marketplace application. This one lets an agent reach you about it.

Why this is a second box and not a paragraph in the first one

Permission to act as your agent and permission to telephone you are two different things under two different rules. Bundling them would mean you could not agree to one and refuse the other. So they are separate, and refusing this one does not stop us helping you.

Where we would reach you

The consent below applies to exactly the number and address you put here.

Format (000) 000-0000. This is the number the consent covers.

What you are agreeing to

English. This is the version you are signing.

This consent is our own text, not a federal form, so the language you are reading is the language that governs it.

I, [First Name] [Last Name], give Sunrise Health Enrollment and the licensed agents working for it my express written consent to contact me at [the number given above] and at [the email address given above] about Health Insurance Marketplace coverage: my application, what I may qualify for, the premium tax credit, and enrolling in or keeping a plan.

I understand and agree that:

  • these calls and text messages may be made using an automatic telephone dialing system or an artificial or prerecorded voice;
  • my consent is not a condition of buying any goods or services, and I can get the same help by telephoning the agency myself;
  • message and data rates may apply, and message frequency varies;
  • I may withdraw this consent at any time by replying STOP to a text message, by telling the agent during a call, or by writing to the agency email address printed on the previous stage, and that it takes effect immediately;
  • this consent covers only the telephone number and email address written above and no others.

I understand that this is a demonstration website. No number is dialled, no message is sent, this consent is not stored on any server, and nothing about it is passed to any insurance company or to the Marketplace.

sunrise-contact-consent-2026.1

What is recorded with your signature

A signature is only worth something if there is a record of what was signed and by whom. Here is the whole list. There is nothing else, and nothing hidden.

Recorded by our server

Collected by Cloudflare when your browser makes the request. You cannot change these, and neither can we.

  • The time the request arrived, in UTC
  • Your IP address
  • The country, region, city and postal code Cloudflare associates with that address
  • Your network operator and its ASN
  • Which Cloudflare data centre answered
  • The HTTP protocol and TLS version used
  • The time zone Cloudflare associates with that address
  • The full user agent string your browser sends
  • The languages your browser asks for
  • The page you came from
  • A reference number generated for this record

Reported by this page

Read in your browser and sent up with the form. Labelled as client reported, because a browser can be told to say anything.

  • Your clock, in UTC and in local time
  • Your time zone and its offset from UTC
  • The languages your browser is set to
  • Your platform and browser, as your browser describes them
  • Your screen size and colour depth
  • The size of this window
  • Your device pixel ratio
  • Your reduced motion, colour scheme and pointer settings
  • The page you landed on, this page, and the page that sent you here
  • How long you spent on each step, and in total
  • The version and SHA-256 hash of each consent text you were shown, and in which language

Why the hash matters

The hash is a fingerprint of the exact words on this page. If a single character of the consent changed, the fingerprint changes. It is what proves later which text you agreed to, and the record says which language version you were reading when you agreed to it.

Your signature itself

The picture of your signature stays in this browser. What goes to the server is its SHA-256 hash, its size and how much ink is on it, which is enough to bind this record to the mark you made. The picture is put back into the copy you download.

What is deliberately not collected No canvas or WebGL fingerprinting, no font enumeration, no audio fingerprinting, and no other covert device signal. An audit trail records something you chose to do. It is not a tracking apparatus, and building one here would undermine the consent this form exists to collect.

Your express written consent

Rather we did not?

Then do not tick it. Call us on the number below and a licensed agent will pick up. You can also finish the rest of this form and leave this consent unsigned, and nothing about your quote changes.

Sign here

Use a finger, a mouse or a stylus. If you would rather type it, switch below.

Empty

Date signed:

Back

Rather not do this alone?(305) 555-0148orAsk us to call you

Nothing here is sent anywhere. Demonstration. No application is transmitted to CMS or any carrier.

How to withdraw it

Reply STOP to any text message, tell the agent on the call, or write to the agency email printed on the previous stage. It takes effect immediately.

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