Submit a Lead

Enter the code or ID provided to you.

Agent Code

Provided by the marketing manager.

Agent UID

The agent's unique ID — found in the agent's app under Settings → Account.

Business Code

Provided by the marketing manager.

Business ID

The business UUID — found in the agent's app under Settings → Account.

Why this matters: Every lead is permanently attributed to your marketing team. Using the correct code ensures accurate tracking in your dashboard.

Looking up agent…

Invalid Code

Need help? Contact your marketing manager or the agent directly to verify the correct code.

Select the agent you are submitting this lead for:

Submitting lead to:

Fields marked * are required.

Select Agent

Choose a specific agent or leave as "Auto-assign" for the agency's queue.

Full Name *

Phone Number *

Email Address

Gender *

Date of Birth *

Medicare Beneficiary ID

Medicare Coverage

Part A Part B Parts A&B

Medicare Effective Date

Medicaid Status

Current Carrier

Street Address

City

State *

ZIP

Preferred Contact Time

Estimated Annual Income

Your Name (Rep)

Lead's Needs

Select all that apply — auto-added to notes for the agent

Part B Giveback Flex Card (DVH) Food Card Reduced DR Copays Reduced RX Copays Wider RX Coverage Doctor Not In Network Dental Vision Hearing Not Locked Into A Network Annual Review

📋

DISC Profile (Optional)

Select the lead's primary and secondary behavioral style

Primary

Secondary

Additional Notes for Agent

Live Call Transfer

Currently on the phone with this lead? Transfer the call to the agent right after submitting.

Stay on the line with the lead, introduce them to the agent, then drop off.

⚠ Your lead was NOT submitted. Something went wrong on our end. Please try again or contact support. Your form data is still filled in.

Lead Submitted!

The agent has been notified and will follow up with this prospect shortly.

Transfer Number

If the lead is on the phone, transfer them to this number.

Lead Submitted!

Transfer the call now — the agent has already been notified.

Transfer to

Warm Transfer Steps:

Put on hold on your VoIP system
Transfer to the number above
Wait for the agent to answer and introduce the lead
Drop off once the agent has them

Cold Transfer Steps:

Blind transfer to the number above
You're done — the agent is already notified and ready

The agent received a push notification. Their caller ID will show the lead's number.