THE ADKISSON GROUP
Gratitude and thank you

Thank You, !

Before we show the calendar, let's get your details so we can follow up and help you choose the right coverage.

This quick step makes sure your request doesn't get lost if life gets busy before you schedule. Once you submit your information, you'll continue to your appointment options.

STEP 1 OF 2

Step 1: Tell Us Where To Start

Capture your information first, then continue to the appointment calendar. This helps our team follow up with the right guidance even if you get interrupted before scheduling.

Final Expense • Term Life • Permanent Life • Living Benefits • IUL

Complete This Quick Pre-Appointment Form

Use structured questions so we can segment your needs, personalize follow-up, and guide you to the right next step before you book.

CONTACT DETAILS
First Name

Last Name

Mobile Phone

Email

State

ABOUT YOUR NEEDS
Age Range 
Primary Goal 
How soon you're looking for coverage 
Approximate coverage amount 
Age Range
Primary Goal
How soon are you looking for coverage?
Approximately how much coverage are you considering?

Please make your selections and complete your contact details below. This information will be captured with your lead profile so our team can review your answers before follow-up.

Step 02

Step 2: What Would You Like Your Life Insurance To Accomplish?

Immediately after they opt in, let the customer identify what they need most. This helps segment the prospect before the conversation ever begins.

Select an option below to continue and share what kind of protection you're looking for.

Choose the path that fits your goals best.

Use this exact instruction in the AttractWell AI editor to repair the section functionality:

Please repair the interactive questionnaire/form section of this funnel. Do not redesign or remove the existing questions, wording, branding, layout, or overall funnel structure unless necessary for functionality. The current problem is that visitors can see the answer choices and text-entry boxes, but they cannot actually select the answers or type responses into the text fields. The fields appear visually, but they are not functioning as interactive form fields. I need you to convert every question in this section into a fully functional lead-capture form connected to the CRM/contact profile. Please make the following changes: 1. Multiple-choice questions must be clickable and selectable. - Use functional radio buttons when the client should select only one answer. - Use functional checkboxes when the client should be allowed to select multiple answers. - The entire answer option/label should be clickable, not just a tiny radio button or checkbox. - The selected answer should visibly show that it has been chosen. 2. Text-answer questions must use real editable input fields. - Short answers should use functional text input fields. - Longer answers should use functional text-area fields. - Clients must be able to click or tap inside the box and type their response. - Placeholder text must disappear or move appropriately when the client begins typing. 3. Every question must be connected to a CRM/custom contact field. - Create or connect a unique contact/custom field for every question. - Do not simply display the response on the page. - The client's selected or typed response must be saved permanently to that client's lead/contact profile after the form is submitted. - Use clear field names so the responses can easily be identified later inside the CRM. 4. The form must identify the lead correctly. - The questionnaire responses must be attached to the same contact record created from the client's name, email address, phone number, or other lead information. - Do not create disconnected responses that cannot be traced back to the individual client. 5. Prepare the responses for tags and automation. - Responses must be available as triggers or conditions for CRM automations. - I need to be able to create tags based on specific answers. - I need those tags to be usable to start campaigns, email sequences, text-message sequences, internal notifications, follow-up tasks, appointment workflows, and other automated actions. Example: If a client selects a particular service or need, that response should be saved to the CRM and be capable of triggering the corresponding tag and campaign. 6. Do not use static design elements as answer fields. - Do not use text boxes, buttons, cards, shapes, or containers that only LOOK clickable. - Every answer option must use an actual functional form control connected to the CRM. 7. Preserve the current funnel design. - Keep the existing colors, branding, questions, wording, and general page appearance. - Only adjust spacing or layout when necessary to make the questionnaire easier to complete. 8. Make the form work on both desktop and mobile devices. - Clients must be able to tap answers easily on a phone or tablet. - Text fields must open correctly for typing. - No fields should overlap or become inaccessible on mobile devices. 9. Validate required information. - Questions marked as required should prevent the client from continuing until they provide an answer. - Clearly identify any required unanswered question instead of allowing the form to fail silently. 10. Make the Continue/Next/Submit button functional. - The button should save all responses to the client's CRM/contact profile. - After successful submission, continue the client to the correct next step of the funnel. - Do not allow the button to appear functional if the information is not actually being recorded. 11. Test the completed form before considering the change finished. Test the funnel as a sample client by: - selecting a radio-button answer; - selecting multiple checkbox answers where permitted; - entering text into every type of text field; - submitting the form; - confirming that the answers were saved to the correct CRM/contact profile; - confirming that the saved information can be used for tags, campaigns, and automation triggers; - confirming that the form works on desktop and mobile. IMPORTANT: This is a functionality repair, not simply a visual redesign. Do not tell me the section has been fixed unless the visitor can actually enter/select responses AND those responses are being stored in the CRM/contact record. If any part cannot be connected automatically, do not create a visual substitute. Instead, clearly identify the exact CRM field, form setting, custom field, workflow, or automation connection that still needs to be manually configured.

Follow with this audit prompt after the repair:

Now audit the funnel you just repaired. Go through every question one by one and confirm: Question → Input Type → CRM Field → Response Saved → Tag/Automation Available I specifically want you to identify any question that is still only a visual element rather than a functional CRM-connected form field. Test every clickable answer, checkbox, radio button, text input, text area, Continue button, and Submit button. Do not change my copy or redesign the funnel during this audit. The final goal is: Visitor answers question → answer is captured → answer is attached to the lead/contact profile → appropriate tag can be applied → tag or answer can trigger the correct automated campaign/action. If anything in that chain is not working, fix it before marking the project complete.

Do not make it LOOK like a form. Make it an actual CRM-connected form.

NEXT STEP

First Submit Your Info, Then Continue To Your Appointment.

This two-step flow helps you collect the lead first, uncover what they need, and then guide them to the calendar with better context and stronger follow-up opportunities.

Capture first. Segment second. Schedule third.