Client Intake — Agent Use
Agent use only · Post-sale

Medicare Client Intake

A guided post-sale workflow for contact, service area, plan selection, Medicare card details, medications, and follow-up automation.

ZIP-to-plan lookup Medication capture GHL-ready payload
Setup needed: this form's send URL isn't configured yet. In this sub-account, copy the Inbound Webhook URL from the intake workflow and paste it into the custom value intake_webhook_url. Until then, submissions are logged to the console for testing.

1Contact information

Client identity Start with the record match.

Phone is the anchor for matching the existing GHL contact and keeping the post-sale intake tied to the right client.

Medicare context

Date of birth helps confirm Medicare eligibility timing and avoids confusion when multiple family members share a phone.

Used as the primary GHL match key. Phone is required — it's how the system matches the existing client and avoids duplicates.
That doesn't look like a valid email.

2Address

Service area ZIP determines the county and available plans.

Once a valid ZIP is entered, the form checks Cloudflare and prepares the plan options for the next step.

What matters

Medicare Advantage availability is county-based, so ZIP accuracy is the first quality check.

ZIP should be 5 digits. County and plan availability are resolved from this ZIP.

3Policy & statusdrives automations

Plan selection Choose the coverage the client actually accepted.

The ZIP lookup feeds the plan list. Selecting a plan fills the plan name and tries to align the carrier automatically.

Coverage fit

MAPD, SNP, supplement, and ancillary products can trigger different follow-up paths in GHL.

Options appear here after a valid ZIP lookup.

4Medicare & health information

Card and care profile Capture the data that affects enrollment quality.

Medicare number, Part A/B dates, doctors, medications, Medicaid, LIS, and income notes support a cleaner application review.

Medication list

Drugs are saved to the lead record. The autocomplete keeps entries consistent for future plan-fit conversations.

Medicare Card Details
Name / Nombre {{user.name}}
Medicare Number / Número de Medicare
Masked on screen and formatted as 4-3-4 characters.
Entitled to / Con derecho a Coverage starts / Cobertura empieza HOSPITAL (PART A) MEDICAL (PART B)
Selected medications are saved as a clean list in the client payload.

5Automationsoptional — your choice

Retention workflow Pick the follow-ups that match this client.

These tags tell GHL which post-sale sequences to activate after the intake is saved.

Agent control

Leave all unchecked when the client should not enter additional follow-up automation.

Pick which follow-ups this client receives. Choose one, a few, or all — or none. Each shows how many messages it sends so there are no surprises.