The Medigap Contact Wizard uses a 5-step multi-page form architecture. Each step is validated before the visitor advances. On final submission, the complete lead is emailed to your notification address and stored as a custom post type (mmw_submission) in your WordPress database. The whole session — including the start time — is tracked to reject bot submissions that complete too quickly.
The 5 steps
Step 1 — Contact Info
Full name (required), email address (required), phone number, ZIP code (required), and state (required). This step collects the core contact record.
Step 2 — Medicare Status
Currently enrolled in Medicare? Which parts (A, B, C, D) — shown only if enrolled. Expected enrollment date — shown if not yet enrolled. Prior Medigap experience. Other health insurance (employer, retiree, Medicaid, VA, TRICARE, none).
Step 3 — Needs & Concerns
Interests (multi-select: lowest premium, best coverage, keep doctor, dental/vision/hearing, prescription savings, no hassle, other). Turning 65 soon. Desired plan start timeline (ASAP, 30 days, 3 months, not sure). Coverage for (self, self and spouse, other).
Step 4 — Health & Prescriptions
Ongoing health conditions (optional, hidden by default). Regular prescriptions? If yes: text list of medications and optional file upload (PDF/image/doc, max 2 MB). Preferred pharmacy (hidden by default). Dental, vision, or hearing coverage needed?
Step 5 — Preferences & Consent
What’s most important in a plan (open text). How they found you (hidden by default). Any other questions (open text). Marketing opt-out checkbox (hidden by default). Privacy Policy consent (required).
Anti-Spam
Two layers of bot protection: a honeypot field invisible to human visitors, and a start-time check that discards submissions completed in under a human-plausible threshold. No CAPTCHA required.
Submission storage
Each submission is stored as a mmw_submission custom post type in WordPress. Go to Medigap Contact Wizard → Submissions in the admin sidebar to view all leads. Field values are stored as post meta. No separate database table is created — all data lives in standard WordPress tables.
Medigap Contact Wizard
A professional 5-step Medigap lead capture form for WordPress. Collects contact details, Medicare status, coverage needs, health info, and consent — then emails the lead and stores it in your dashboard.
