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If you have been selected to participate in the MCBS and would like to have a representative contact you to complete your phone interview, please fill out the fields below and click submit. Thanks in advance for your help with this important study to improve your Medicare services!

*This field is required. The required fields allow us to confirm your status as a current Medicare beneficiary and contact you via phone to schedule an appointment for your phone interview.

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By submitting this form, you give permission to have a MCBS representative call you at the phone number provided to schedule your appointment and answer any questions you have regarding the phone interview.