Find My Plan - indipop

1
Lead Source
Web JotForm
Please Select
Web JotForm
Website Traffic
DEEL
ShearShare
Qwick
Holisticly
From existing member
From Linkedin
LadyM
Red Barn Homes
FibreNew
Apollo
Capital Factory
Thumbtack
Mucker Capital
pocketrn
zaid
foundershield
IFPG
taxhack
flyer
grocery
groceryvs
groceryrx
groceryhsa
founderslive
RBRealty
socialm
socialw
franserve
email
chabad
franchise
jpgtax
meredith
luminary
smith
startupstack
sunny
pool
creations
nurseio
tiktok
TM
chef
IPA
Link
FlatIron
FFP
Carr
Consultants
SGLI
ganas
engage
2
Enroll in Mkt Sequence - Get a QuoteThis hidden field is sent to HubSpot to enroll the contact in the marketing sequence for receiving more information about the selected plan.
Yes
Please Select
Yes
3
I need healthcare for________________* This field is required.
Myself
Parent & Child(ren) or Spouses
Family
4
What state will you be joining a healthcare membership?* This field is required.
5
I want to review:* This field is required.
Show me the most affordable basic options with a low out of pocket for major medical.
Show me the option that is Health Savings Account Compatible.
Show me the option with access to dedicated virtual providers and in-person urgent care visits.
Show me the option that offers Direct Primary Care and copays for in-network person visits.
Show me the option that includes unlimited primary, specialty and urgent care with access to naturopaths, chiropractic care, copays for diagnostic imaging, and more!
Help me customize an option.
I'm not sure - what's indipop's most popular option?
6
Great! Let's get some of your info to start, what's your email?* This field is required.Opt out of communication at any time.
example@example.com
7
What is your first name?* This field is required.
8
What is your last name?* This field is required.
9
We are going to be emailing you the information based on your answers. Now that you've been matched, you have access to the indipop team for answers to your questions. What’s the best way to stay in touch?* This field is required.
I would also like a phone call ☎️
I would like to text with a human 🙋‍♀️
10
Phone Number* This field is required..
Please enter a valid phone number.
11
Infusionsoft Tags
Jotform Find My Plan filled out
12
Infusionsoft Tags
Jotform Find My Plan filled out
13
One last question! Who can we thank for sending you to indipop?
Please Select
Please Select
Linkedin
TrueMed
FFP
Google
Nurseio
IFP
Other
14
One last question! Who can we thank for sending you to indipop? example: FFP, Linkedin, Nurseio, Friend or colleague.
Should be Empty: