About this template
Streamline your client onboarding and quote generation process with this dedicated life insurance intake form. Designed specifically for insurance professionals, this template captures essential contact details, biographical information, desired coverage amounts, and critical health history factors required to prepare accurate policy quotes. By gathering structured information upfront, agents can reduce back-and-forth emails, maintain organized client records, and deliver prompt, tailored insurance proposals.
Built on Google Forms, this template allows you to easily customize questions, share secure links with prospective clients, and automatically store submissions in a connected spreadsheet for seamless pipeline management. Whether you operate an independent agency or manage a larger portfolio, this form ensures a professional, frictionless experience for every client from their very first interaction.
Key features
- Collect complete client contact and demographic details in one submission
- Gather vital health and lifestyle background for accurate risk assessment
- Allow clients to specify their desired coverage plans and amounts
- Automatically organize all responses in Google Sheets for instant quote tracking
- Fully customizable to fit your agency's branding and specific policy offerings
Use cases
New client quote requests for term or whole life policies
Initial medical and lifestyle intake before agent consultations
Online lead capture for insurance agency websites and digital marketi…
Online lead capture for insurance agency websites and digital marketing campaigns
What this form collects
- Full Name (Short answer)Enter your first, middle, and last name as it appears on official government IDs.
- Phone Number (Short answer)Provide a reliable phone number where we can reach you to discuss your quote.
- Email Address (Short answer)We will send your policy options and quote details to this address.
- Date of Birth (Date)Used to calculate accurate premium rates.
- Life Plan Selection (Multiple choice)Select the type of life insurance policy you are most interested in.
- Requested Coverage Amount (Dropdown)Select your desired death benefit or coverage amount.
- Height (Short answer)Enter your height (e.g., 5 ft 10 in).
- Weight (Short answer)Enter your current weight in pounds.
- Health Issues or Medical History Description (Paragraph)List any pre-existing medical conditions, past surgeries, or ongoing treatments. If none, simply type 'None'.
FAQ
How do I customize this life insurance intake form?
Once you copy the template to your Google Drive via Doc2Form, you can freely edit, add, or remove questions to match your agency's specific underwriting questions and plan options.
Where do the client submissions go?
All form responses are instantly saved to a Google Sheet linked directly to your form, allowing you and your team to review client data and generate quotes in real time.
Can I share this form directly with prospective clients?
Yes! You can share the form via a direct link, embed it on your agency website, or send it in an email following an initial inquiry.
Is this template free to use?
Yes, this template is completely free to copy, use, and customize through Doc2Form and Google Forms.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.