Step 1 of 7
What do you need coverage for?
Select your primary coverage need — add others on the next page.
🏥
Medicare
Advantage, Supp, Part D
❤️
Health Insurance
Individual or family
🛡️
Life Insurance
Term, whole, final expense
🏢
Group Benefits
Employer health & dental
🌿
Long-Term Care
Home care & assisted living
🏨
Hospital Indemnity
Cash benefits during stays
How did you find us?
Step 2 of 7
About You
Primary applicant information.
Found on your red, white & blue Medicare card.
📞 Phone
💬 Text
📧 Email
Step 3 of 7
Health Information
Helps us match you with plans that cover your needs and medications.
No
Yes — Cigarettes
Yes — Vaping / Other
Health Conditions
❌ None
🩺 Diabetes
❤️ Heart Disease
🫁 COPD / Asthma
🧠 Stroke / TIA
🦀 Cancer
🦴 Arthritis
🧬 Kidney Disease
😰 Depression / Anxiety
🔮 Other Chronic
Doctors & Medications
We use this to find a Part D plan that minimizes your drug costs.
Step 4 of 7
Coverage Details
Specific questions based on what you need.
Medicare
🏥 Medicare Advantage (Part C)
📋 Medicare Supplement (Medigap)
💊 Part D Drug Plan
📖 Just want to understand options
Life Insurance
Term Life
Whole Life
Final Expense
Not Sure
Health Insurance
Just me
Me + Spouse
Me + Child(ren)
Whole Family
Step 5 of 7
Current Coverage
Knowing your current plan helps us find you something better.
Yes, I have coverage now
No / First-time applicant
💰 Rate increase
📋 Plan changes
👨⚕️ Lost my doctor
💊 Drug not covered
😤 Poor service
📆 Annual review
Existing Life Insurance
Yes
No
Step 6 of 7
Preferences & Goals
Help us find the best fit for you.
💰 Lowest premium
🛡️ Most coverage
👨⚕️ Keep my doctors
💊 Best drug coverage
⚖️ Balanced
HMO (stay in network)
PPO (see any doctor)
No preference
Agent Notes — Internal Only
🔒 Not visible to client
Client Notes
🌅 Morning (9–12)
☀️ Afternoon (12–3)
🌇 Late Afternoon (3–5)
Step 7 of 7
Review & Export
Confirm everything, then download for HawkSoft.
Coverage Edit →
Personal Info Edit →
Current Coverage Edit →
Intake Complete!
Download below — the CMSMTF file imports directly into HawkSoft with a double-click. No manual entry needed.
Reference #SFC-000000
HawkSoft Import File
Double-click to import client directly into HawkSoft. No typing required.
CSV Backup
Full spreadsheet for manual entry, filing, or sharing with your team.