Life insurance quote form template
This seven-step life insurance quote form asks the type of cover, smoking status, medical conditions, current cover, cover amount and date of birth, followed by contact details and consent. Clone it into your Growform account and rename the products.
What the form asks, step by step
This is the life insurance questionnaire a broker would run on a first call, turned into a form. Each answer button moves the customer to the next step.
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Step 1: “What would you like cover for?”
Family, mortgage, both or end of life tells the broker which product to quote.
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Step 2: “Do you smoke?”
Smoking status is the biggest pricing factor and takes one tap to answer.
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Step 3: “Do you have any pre-existing medical conditions?”
A yes here warns the broker to expect a longer underwriting conversation.
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Step 4: “What stage are you at with life insurance?”
Existing cover, no cover yet or just curious shows how serious the inquiry is.
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Step 5: “How much cover do you need?”
A typed amount means the quote can be run straight from the submission.
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Step 6: “What is your date of birth?”
Age is the other half of the price and gets a step of its own.
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Step 7: “How shall we contact you about your quotes?”
Name, email, phone and a consent checkbox come last.
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After submitting
The customer sees “Thanks for your enquiry! Thanks for getting in touch. We’ll be in contact soon.”
Who it’s for
This template is built for brokers, comparison sites and lead generation agencies that send paid traffic to a quote page and need each life insurance lead form submission to arrive ready to price. The six questions cover the first two minutes of a broker’s call, so the call itself can start at minute three. It also works as a life insurance fact find on a broker’s own website, in place of a callback box that produces a phone number and nothing else.
Why this structure converts
- Six easy questions about cover, smoking, conditions, stage, amount and date of birth come before any personal data.
- Every answer visibly changes the price, so none of the questions feels like padding.
- Consent is an explicit checkbox on the last step, which makes the lead usable for follow-up calls.
- The purchasing-stage question lets “just curious” leads go to a nurture sequence instead of a same-day call.
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Make it yours
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Add a conditional step for conditions
When the customer answers yes to pre-existing conditions, show one extra step asking which, so underwriting is not a surprise on the call.
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Localize the products
“End of life” reads as over-50s cover in the UK and final expense in the US. Rename the options to the products you sell.
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Prove consent for buyers
If you sell leads to other brokers, turn on TrustedForm or Jornaya certification. Both work with Growform forms.
Frequently asked questions
What questions does a life insurance quote form ask?
This template asks what the cover is for, whether the person smokes, whether they have pre-existing medical conditions, where they are in their search, how much cover they need and their date of birth. It then asks for name, email, phone and consent to be contacted.
How is this different from a life insurance application form?
An application form collects the full medical and financial disclosures an insurer underwrites on. This template stops well short of that. It is a short questionnaire whose answers let a broker price and prioritize the lead, and the application happens with the insurer after the quote.
Does the form collect consent for follow-up calls?
Yes. The final step includes an “I’m happy to be contacted by email or phone about my quotes” checkbox. You can make it required and change the wording.
Where do the leads go?
Leads go to your email by default and to your CRM or dialer through Growform’s integrations. Insurance agency CRMs such as EZLynx and AgencyZoom are supported, and our guide to insurance quote forms covers the follow-up side.
What happens next?
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Step 1: Clone this form template
Clone this template into your Growform account (create one first if you don’t already have one). -
Step 2: Edit your form
Get creative and adjust your form's theme options, questions or layout in the Growform form builder. -
Step 3: Share or embed your form
Share a link to your form, or embed it in your existing website. Receive new submissions by email or send them to 7,000+ apps via Zapier.
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