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  • Individual & Family
    • Affordable Care Act (ACA)
    • Affordable Care Act (ACA) FAQ
    • Dental/Vision Plans
    • Small Business
  • Additional Coverage
    • Hospital Indemnity
    • Cancer Policies
    • Critical Care
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    • Final Expenses
  • Find an agent
  • Events
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    • Staff
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    • Become An Agent
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  • Medicare
    • Medicare Supplement
    • Medicare Advantage (Part C)
    • Prescription Drug Plans
    • Medicare FAQ
  • Individual & Family
    • Affordable Care Act (ACA)
    • Affordable Care Act (ACA) FAQ
    • Dental/Vision Plans
    • Small Business
  • Additional Coverage
    • Hospital Indemnity
    • Cancer Policies
    • Critical Care
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New Agent Intake Form

Home/New Agent Intake Form
New Agent Intake Formeplatinum2022-05-05T12:09:41-05:00
  • (if different from home)
    NOTE: must utlilize EPH to have a website and/or business cards
  • (firstinitial last name)@myeph.com
  • Max. file size: 50 MB.
    Your Individual and/or agency license for any states you will be selling in.
  • Drop files here or
    Max. file size: 50 MB.
      Please provide your current E&O certificate
    • Accepted file types: jpg, png, Max. file size: 50 MB.
      500x700px please

    ePlatinumHealth

    ePlatinumHealth is a full-service health insurance agency with offices throughout the United States. Each ePlatinumHealth office is independently owned and operated.

    Neither ePlatinum Health nor its agents are connected with the Federal Medicare Program.

    We do not offer every plan available in your area.  Any information we provide is limited to those plans we do offer in your area.  Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

    ePlatinum Health

    W156 N8327 Pilgrim Rd Suite 101
    Menomonee Falls, WI 53051

    16800 W Greenfield Ave Suite 400
    Brookfield, WI 53005

    1-844-EPH-LIVE

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