URLThis field is for validation purposes and should be left unchanged.We have several different ways to counsel clients during Annual Enrollment. You can sign up for some of these counseling options using this form. PLEASE only sign up for one option. 1) Plan Finder Counseling by phone 2) Counseling Event at Rossmoor or in Pleasant Hill 3) Site Counseling at locations around the County Name(Required) First Last Phone Number(Required)Zip Code(Required)Email(Required) Enter Email Confirm Email Does your spouse also want counseling? Check this box if you also want to schedule your spouse for counseling Select the type of counseling you prefer:(Required) Plan Finder Counseling Session (by phone) Counseling Event (in-person event on 10/29, 11/14, or 11/19) Site Counseling (in-person at various locations) Are you a Rossmoor Resident?(Required)Select YES or NOYESNOSelect ALL of the appointment days/times you are available to attend(Required) Thursday, October 29, 9 AM to 11:15 AM Thursday, October 29, 12:30 PM to 2:45 PM Thursday, November 29, 9 AM to 11:15 AM Thursday, November 29, 12:30 PM to 2:45 PM Select ALL of the appointment days/times you are available to attend(Required) Saturday, November 14, 9 AM to 11:15 AM Saturday, November 14, 12:30 PM to 2:45 PM You are signing up for a Plan Finder Counseling Session. A HICAP Counselor will contact you by phone or email, in the next 5 days, to arrange a time for you to meet. Please hit SUBMIT to complete your registration.You are signing up to attend a Counseling Event. You will receive a confirmation email with the day and time of your appointment. That email will contain instructions for you to complete prior to your appointment. Please hit SUBMIT to complete your registration.You are signing up to attend a Counseling Event. You will receive a confirmation email with the day and time of your appointment. That email will contain instructions for you to complete prior to your appointment. Please hit SUBMIT to complete your registration.If you need to refer to the Counseling Locations page, you should open that in a new tab. If you switch to it from this screen you might lose the information you have entered. Enter the CITY and DATE of your preferred choices for appointment location and time. Enter them in the order of preference. You must enter at least 2, but for best results, enter 3 choices. You may enter the same location on two different days. EXAMPLE: “Brentwood, Nov 5”First choice(Required)Second Choice(Required)Third ChoiceYou are signing up to attend a site counseling appointment. You will receive a confirmation email with the day, time, and location of your appointment. That email will contain instructions for you to complete prior to your appointment. Please hit SUBMIT to complete your registration.
