precisionmedicare.healthiq.com
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Submitted URL: http://precisionmedicare.healthiq.com/
Effective URL: https://precisionmedicare.healthiq.com/
Submission: On March 01 via api from US — Scanned from US
Effective URL: https://precisionmedicare.healthiq.com/
Submission: On March 01 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
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<p class="css-1a6mm5r-QuoteBlockQuote-QuoteBlockQuote es5vy085">“My Health IQ agent helped find exactly what I needed at no extra cost or copay for me. I cannot thank her enough. She took time and patience with me.”²</p>
<p class="css-rfk98b-QuoteBlockQuotedCustomer-QuoteBlockQuotedCustomer es5vy086">– <b>Betty M.</b> (Real Health IQ Medicare Customer)</p>
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<div class="css-dnqes7-SignupRightContentInnerWrapperSmallPadding-SignupRightContentInnerWrapperSmallPadding es5vy082">
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<div class="css-g0ch81-BannerTitleSectionContentWrapper-BannerTitleSectionContentWrapper ek1fw5w1">
<p class="css-391fgv-BannerTitle-BannerTitle ek1fw5w2">Tell us more about yourself</p>
<p font-weight="700" font-size="18" class="css-sqlihg-BannerSubtitle-BannerSubtitle ek1fw5w3">So we can find the Precise Plan for you</p>
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<h3 class="css-lj8dt-PageSectionTitle-PageSectionTitle er2kxqd28">1. Tell us who you are</h3>
<p font-size="16" class="css-p9ekme-PageText-PageText er2kxqd29">Already have an account? <a href="/login">Log in here</a></p>
<div class="css-gi6id-QuestionWrapper-QuestionWrapper er2kxqd39">
<div class="css-1n2k1ms-QuestionContainer-QuestionContainer ezli6bm0"><label for="first_name" class="css-1rd3tdc-TitleText-TitleText ezli6bm4">First Name</label><input type="text" name="first_name" autocomplete="given-name"
placeholder="e.g. John" id="first_name" class="css-9s6j7t-TextInputContainer-formInputStyle-formEntryStyle-TextInputContainer e5g00fr0" value=""></div>
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<div class="css-1n2k1ms-QuestionContainer-QuestionContainer ezli6bm0"><label for="last_name" class="css-1rd3tdc-TitleText-TitleText ezli6bm4">Last Name</label><input type="text" name="last_name" autocomplete="family-name"
placeholder="e.g. Doe" id="last_name" class="css-9s6j7t-TextInputContainer-formInputStyle-formEntryStyle-TextInputContainer e5g00fr0" value=""></div>
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<div class="css-1n2k1ms-QuestionContainer-QuestionContainer ezli6bm0"><label for="address_zip" class="css-1rd3tdc-TitleText-TitleText ezli6bm4">Zip Code</label><input type="tel" name="address_zip" placeholder="_ _ _ _ _" id="address_zip"
class="css-9s6j7t-TextInputContainer-formInputStyle-formEntryStyle-TextInputContainer e5g00fr0" value=""></div>
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<div class="css-1keagyi-CountySearchWrapper es5vy087"><label class="css-1rslt6z-CountySearchLabel es5vy088">County</label><input type="text" name="county_name" placeholder="Enter a valid zip code" disabled=""
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id="date_of_birth" class="css-9s6j7t-TextInputContainer-formInputStyle-formEntryStyle-TextInputContainer e5g00fr0" value=""></div>
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<div class="css-fyzm3y-LabelText-LabelText e1qzpweh4">Under the penalty of law. I certify that I am requesting records for myself, and not for any other person. I understand that this record is necessary to find my Precision
Medicare plan.</div><input id="under_law_disclaimer4" type="checkbox" class="css-8iaszy-Input-Input e1qzpweh2" checked=""><span class="css-10jkosl-Checkmark-Checkmark e1qzpweh1"></span>
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<p class="css-1ndu8ws-PageText-PageText er2kxqd29"><b>Don't want to complete this form?</b> <a>Call one of our licensed insurance agents</a> or <a>click here</a> to view all plans in your area.</p>
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<h3 class="css-1t7951h-PageSectionTitle-PageSectionTitle er2kxqd28">2. Set up your account</h3>
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<div class="css-1n2k1ms-QuestionContainer-QuestionContainer ezli6bm0"><label for="phone_number" class="css-1rd3tdc-TitleText-TitleText ezli6bm4">Mobile Phone</label>
<p class="css-8p2nth-HelpText-HelpText-SubtitleText-SubtitleText ezli6bm2">Your mobile number will be used for verifying your account.</p><input type="tel" name="phone_number" autocomplete="tel" placeholder="(___)-___-____"
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<div class="css-1n2k1ms-QuestionContainer-QuestionContainer ezli6bm0"><label for="password" class="css-1rd3tdc-TitleText-TitleText ezli6bm4">Password</label>
<p class="css-8p2nth-HelpText-HelpText-SubtitleText-SubtitleText ezli6bm2">8 or more characters long. Please include at least 1 number, 1 uppercase letter, 1 lowercase letter and 1 special character.</p><input type="password"
name="password" placeholder="Password" data-openreplay-obscured="true" id="password" class="css-9s6j7t-TextInputContainer-formInputStyle-formEntryStyle-TextInputContainer e5g00fr0" value=""><button type="button"
class="css-1a6ip8o-BaseButton-animatedStyle-BaseButton-LinkButton-LinkButton-LinkDarkButton-LinkDarkButton-buttonCssStyles etcxsfc37">Show</button>
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<div class="css-1n2k1ms-QuestionContainer-QuestionContainer ezli6bm0"><label for="sms_subscribed" class="css-1rd3tdc-TitleText-TitleText ezli6bm4">Stay Informed</label>
<div class="css-1xefk90-CheckboxWrapper-CheckboxWrapper e3123bt0">
<div class="css-1sboug5-CheckboxWrapper-CheckboxWrapper e1qzpweh0"><label for="sms_subscribed5" class="css-e3x2hp-Label-Label-smsSubscriptionCheckboxLabelStyle e1qzpweh3">
<div class="css-fyzm3y-LabelText-LabelText e1qzpweh4">By checking this box you agree to receive marketing text messages.</div><input id="sms_subscribed5" type="checkbox" class="css-8iaszy-Input-Input e1qzpweh2"><span
class="css-10jkosl-Checkmark-Checkmark e1qzpweh1"></span>
</label></div>
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<div class="css-1riw4q9-ButtonWrapper-ButtonWrapper er2kxqd42"><button type="submit"
class="css-128ph3h-BaseButton-animatedStyle-BaseButton-FilledButton-FilledButton-GreenButton-GreenButton-GreenButtonWide-GreenButtonWide-GreenButtonMaxWide-GreenButtonMaxWide etcxsfc19">Get Started</button></div>
<p class="css-grvcai-LegalText-LegalText es5vy081">By clicking "Get Started", you agree to our <a target="_blank" href="https://healthiq.com/privacy-policy">Privacy Policy</a> and
<a target="_blank" href="https://www.healthiq.com/terms-of-use">Terms of Use</a>. You also agree to Health IQ and its agents contacting you with offers for insurance at the phone number and email address provided using recurring automated
and/or prerecorded calls, texts, and/or emails. You also give Health IQ's licensed sales agents permission to contact you about Medicare Advantage, Medicare Supplement, prescription drug plans, and other insurance products. You can buy a
policy without agreeing to these terms by calling 1 (800) 549-1664. Reply STOP to opt-out and HELP for help. Message and data rates may apply. Message frequency varies.</p>
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