Health Insurance Lead Sample
Below is a sample containing the data fields that we attempt to capture and any leads you purchase at agedleadstore.com will always be in same column arrangement which is similar to or exactly the below. Each of our vendor's forms have different fields and info each consumer opts to fill in varies but you will always receive at least the required fields below indicated by an asterisk. The leads will be retrievable upon purchase in the orders area in a .csv format that will open right up into an Excel Spreadsheet if you have Excel on your computer. You should be able to print 30-50 leads per excel spreadsheet page depending on font size you select.
| Contact Information | |
| Date/Time*: | 1/1/2012 12:20 |
| Applicant Name*: | John Doe |
| Street Address*: | 1234 Main St. |
| City*: | Los Angeles |
| Zip Code*: | 90016 |
| Phone Number*: | (310) 555-1212 |
| Best Time to Call*: | Evening |
| Email Address*: | john@example.com |
| IP Address: | 127.0.0.1 |
| Policy Information | |
| Currently Insured: | Yes |
| Current Carrier: | Aetna |
| Length with Company: | 3 Years |
| Coverage For: | Family |
| Denied Insurance: | No |
| Desired Deductible: | $1,000 |
| Desired Coinsurance: | $20 |
| Desired Plan Type: | PPO |
| Employed: | Yes |
| Marital Status: | Married |
| Medical Information | |
| Date of Birth*: | 1/1/1970 |
| Gender: | Male |
| Height: | 6 Feet 1 Inches |
| Weight: | 180 Pounds |
| BMI: | 24.7 |
| Pre-existing Conditions: | No |
| Smoker: | No |
| Drinker: | No |
| Hospitalized Before: | No |
| DUI or DWI Before: | No |
| Current Medications: | Blood pressure |
| Past Medications: | None |
| Comments: | In good health |
| Spouse Medical Information | |
| Spouse Name: | Jane Doe |
| Spouse Date of Birth: | 1/1/1970 |
| Spouse Height: | 5 Feet 7 Inches |
| Spouse Weight: | 150 Pounds |
| Spouse Smoker: | No |
| Children Medical Information | |
| Child 1 Name: | Jack Doe |
| Child 1 Date of Birth: | 1/1/2000 |
| Child 1 Height: | 4 Feet 4 Inches |
| Child 1 Weight: | 75 Pounds |
| Child 1 Smoker: | No |
| Child 2 Name: | N/A |
| Child 2 Date of Birth: | N/A |
| Child 2 Height: | N/A |
| Child 2 Weight: | N/A |
| Child 2 Smoker: | N/A |
| Child 3 Name: | N/A |
| Child 3 Date of Birth: | N/A |
| Child 3 Height: | N/A |
| Child 3 Weight: | N/A |
| Child 3 Smoker: | N/A |