Agent lead flow

Create lead

Choose the fastest path for the lead or walk through the full underwriting questions.

Quick form

Use the current lead form when you want the fastest way to start quoting.

State

Coverage

Sex

Nicotine user?

Date of birth

ZIP Code

Years of coverage

Risk Class

Computed from underwriting answers.

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Salesforce

Search for an existing lead and overwrite the available underwriting fields.

Form progress

Tell us a bit about yourself.

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Section 1

Tell us a bit about yourself.

We'll use these basics to shape the rest of the recommendation path.

First name

Last name

Date of birth

ZIP code

Are you a U.S. citizen?

Phone

Section 2

Let's learn more about your household.

These questions help shape the recommendation around the people who depend on you.

Do you have a spouse?

Do you have any dependent children?

Section 3

Current coverage and preferences

Do you have any life insurance today?

Exclude any group or employer coverage.

Section 4

Coverage details

How much coverage are you looking for?

Select the total amount of protection you want to shop for.

How many years of coverage do you want?

What's your annual income?

Section 5

Underwriting basics

Height (feet)

Height (inches)

Weight (pounds)

Gender

Do you use nicotine?

Section 6

A few health history questions.

Select everything that applies. Leaving a list empty means none of these apply.

In the past 10 years, have you been diagnosed with any of the following?

Select all that apply.

Are any of these statements true?

Select all that apply.

How many prescriptions are you currently taking?

We'll ask only the follow-up medication details that matter.

Section 7

Medical and family follow-up

Have you been hospitalized overnight in the last year?

In the last 5 years, have you become disabled, applied for, or received disability benefits or worker's compensation?

Have you had a biological parent or sibling die prior to age 60 due to a medical condition?

Section 8

Lifestyle and history detail

These are the items the carrier guides actually key on when they set a class.

When did they last use tobacco or nicotine?

Includes vaping, pouches, patches and chewing tobacco.

Blood pressure

Cholesterol / HDL ratio

Leave as not known if it hasn't come up on the call.

Moving violations in the last three years

DUI, reckless driving or license suspension

Alcohol or drug treatment

Underwriting questions