Rounded Rectangle:

The following forms are required for setting up a new group membership with CPR-ASO:

1. ASO Membership Agreement (print, complete, sign, and return)

2. Broker of Record Letter (print, complete, sign, and return)

3. Draft Authorization Agreement (print, complete, sign, and return)

4. Notice of Privacy Practices (print for your records only)

5. Employee Election Form (Each employee that will not be enrolling and answering health questions through the online enrollment must print, complete, sign, and return this Questionnaire)


*Any group coming in by referral, please be sure to include “Referred by ...” and the referring person’s name and phone # at the top of your ASO Membership Agreement.


Forms may be returned by one of the following methods:

Fax to:

(972) 724-8904


Scan and Email to:


Mail to:


Attn: Enrollment Dept.

3535 Firewheel Drive Ste A

Flower Mound TX 75028


Please direct any questions to or call (972) 724-8900 during normal business hours CST.



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