Health Plan Enrollment — shared by the community

Who this template is for

Health Plan Enrollment is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.

• Small teams who need a reliable intake process working in insurance.
• Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
• Anyone replacing chasing missing details over email with one structured record per enquiry.
• Respondents are the people you send it to — the form asks them 24 questions across 3 screens.
• Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.

• 14 questions are required, so submissions arrive complete instead of needing a follow-up email.
• It collects a verified email address so replies and confirmations land.
• It captures a phone number for urgent follow-up.
• It records a signature you can keep as proof of agreement.
• It pins the request to a specific date.
• It captures a full postal address.
• It allows multiple selections without free text.
• Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

1. 1Press “Use this template” — a fresh copy of Health Plan Enrollment lands in your workspace, ready to edit.
2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

• Features conditional validation: if “Are you adding dependants?” is Yes, “Dependants: name, date of birth and relationship” becomes mandatory before the form can be sent.
• Features conditional validation: if “Do you have health cover now, or have you had recently?” is Yes, “Which insurer and plan, and when does it end?” becomes mandatory before the form can be sent.
• Features conditional validation: if “How is the plan being paid for?” is I pay it myself, “How often would you like to pay?” becomes mandatory before the form can be sent.
• Features conditional validation: if “Does any dependant live at a different address?” is Yes, “Which dependant, and what is their address?” becomes mandatory before the form can be sent.
• All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.