dougallgpt.com Open in urlscan Pro
2606:4700::6812:13f0  Public Scan

Form analysis
2 forms found in the DOM

<form data-testid="loginStandardForm">
  <div class="MuiFormControl-root MuiFormControl-fullWidth css-a6120m-loginEmailInputContainer"><label class="MuiFormLabel-root MuiFormLabel-colorPrimary css-gpk4x8-traditionalLabel" for="email">Email Address*</label>
    <div class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl css-1a2zu3v-traditionalInput"><input aria-invalid="false" id="email" placeholder="Please enter your professional email"
        type="email" data-testid="form-input" class="MuiInputBase-input MuiOutlinedInput-input css-1x5jdmq" value="">
      <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline css-igs3ac">
        <legend class="css-ihdtdm"><span class="notranslate">​</span></legend>
      </fieldset>
    </div>
  </div>
  <div class="MuiBox-root css-dvxtzn"><button
      class="MuiButtonBase-root MuiButton-root MuiButton-contained MuiButton-containedPrimary MuiButton-sizeMedium MuiButton-containedSizeMedium MuiButton-colorPrimary MuiButton-root MuiButton-contained MuiButton-containedPrimary MuiButton-sizeMedium MuiButton-containedSizeMedium MuiButton-colorPrimary css-1lljiwk-loginEmailSubmitButton"
      tabindex="0" type="submit">Enter<span class="MuiTouchRipple-root css-w0pj6f"></span></button>
    <div class="MuiBox-root css-1ofqig9">
      <div>
        <p class="MuiTypography-root MuiTypography-body1 css-ofddnx-loginWithEmailInstruction">A log in link will be sent to the email provided above.</p>
        <div class="MuiBox-root css-r82zjw-textDividerContainer">
          <hr class="MuiDivider-root MuiDivider-fullWidth css-1yasmz2">
          <p class="MuiTypography-root MuiTypography-body1 css-1vq4oo6">or</p>
          <hr class="MuiDivider-root MuiDivider-fullWidth css-1yasmz2">
        </div>
      </div>
    </div>
  </div><input name="txtResult" id="txtResult" style="height: 20px; width: 400px; display: none;"><input type="text" name="RVid" id="RVid" style="width: 400px; display: none;"><input type="text" name="isNew" id="isNew"
    style="width: 400px; display: none;"><input type="text" name="Country" id="Country" style="width: 400px; display: none;"><input type="text" name="OldId" id="OldId" style="width: 400px; display: none;"><input type="text" name="OldIDDate"
    id="OldIDDate" style="width: 400px; display: none;"><input type="text" name="FirstId" id="FirstId" style="width: 400px; display: none;"><input type="text" name="FirstIDDate" id="FirstIDDate" style="width: 400px; display: none;"><input type="text"
    name="GeoIP" id="GeoIP" style="width: 400px; display: none;"><input type="text" name="CIDFlag" id="CIDFlag" style="width: 400px; display: none;"><input type="text" name="TIDFlag" id="TIDFlag" style="width: 400px; display: none;"><input
    type="text" name="CompleteFlag" id="CompleteFlag" style="width: 400px; display: none;"><input type="text" name="CompleteDate" id="CompleteDate" style="width: 400px; display: none;"><input type="text" name="ScreenoutFlag" id="ScreenoutFlag"
    style="width: 400px; display: none;"><input type="text" name="ScreenoutDate" id="ScreenoutDate" style="width: 400px; display: none;"><input type="text" name="TotalCompletes" id="TotalCompletes" style="width: 400px; display: none;"><input
    type="text" name="CSOPanelistID" id="CSOPanelistID" style="width: 400px; display: none;"><input type="text" name="CSOPanelistIDDate" id="CSOPanelistIDDate" style="width: 400px; display: none;"><input type="text" name="CSOPanelistIDStatus"
    id="CSOPanelistIDStatus" style="width: 400px; display: none;"><textarea name="DataPoints" id="DataPoints" style="height: 100px; width: 700px; display: none;"></textarea><input type="text" name="RunTime" id="RunTime"
    style="width: 400px; display: none;"><input type="text" name="ClientIP" id="ClientIP" style="width: 400px; display: none;"><input type="text" name="RVIDHash2" id="RVIDHash2" style="width: 400px; display: none;"><input type="text" name="RVIDHash3"
    id="RVIDHash3" style="width: 400px; display: none;"><input type="text" name="RVIDHash4" id="RVIDHash4" style="width: 400px; display: none;"><input type="text" name="TimeStampHash" id="TimeStampHash" style="width: 400px; display: none;"><input
    type="text" name="Domain" id="Domain" style="width: 400px; display: none;"><input type="text" name="FraudProfileScore" id="FraudProfileScore" style="width: 400px; display: none;"><input type="text" name="FPF1" id="FPF1"
    style="width: 400px; display: none;"><input type="text" name="FPF2" id="FPF2" style="width: 400px; display: none;"><input type="text" name="FPF3" id="FPF3" style="width: 400px; display: none;"><input type="text" name="FPF4" id="FPF4"
    style="width: 400px; display: none;"><input type="text" name="FPF5" id="FPF5" style="width: 400px; display: none;"><input type="text" name="FPF6" id="FPF6" style="width: 400px; display: none;"><input type="text" name="FPF7" id="FPF7"
    style="width: 400px; display: none;"><input type="text" name="FPF8" id="FPF8" style="width: 400px; display: none;"><input type="text" name="FPF9" id="FPF9" style="width: 400px; display: none;"><input type="text" name="isMobile" id="isMobile"
    style="width: 400px; display: none;"><input type="text" name="deviceTime" id="deviceTime" style="width: 400px; display: none;"><input type="text" name="timeZoneDiff" id="timeZoneDiff" style="width: 400px; display: none;"><input type="text"
    name="FPF10" id="FPF10" style="width: 400px; display: none;"><input type="text" name="FPF11" id="FPF11" style="width: 400px; display: none;"><input type="text" name="FPF12" id="FPF12" style="width: 400px; display: none;"><input type="text"
    name="FPF13" id="FPF13" style="width: 400px; display: none;"><input type="text" name="FPF14" id="FPF14" style="width: 400px; display: none;"><input type="text" name="FPF15" id="FPF15" style="width: 400px; display: none;"><input type="text"
    name="rvid_pt" id="rvid_pt" style="width: 400px; display: none;"><input type="text" name="FraudFlagCount" id="FraudFlagCount" style="width: 400px; display: none;"><input type="text" name="udf1" id="udf1"
    style="width: 400px; display: none;"><input type="text" name="IPStatus" id="IPStatus" style="width: 400px; display: none;"><input type="text" name="FraudRiskProbability" id="FraudRiskProbability" style="width: 400px; display: none;"><input
    type="text" name="RVIDPanelistCount" id="RVIDPanelistCount" style="width: 400px; display: none;"><input type="text" name="CustomFactorFlag" id="CustomFactorFlag" style="width: 400px; display: none;"><input type="text"
    name="CustomFactorPanelistId" id="CustomFactorPanelistId" style="width: 400px; display: none;"><input type="text" name="CustomFactorDate" id="CustomFactorDate" style="width: 400px; display: none;"><input type="text"
    name="CustomFactorCompleteDate" id="CustomFactorCompleteDate" style="width: 400px; display: none;">
</form>

<form data-testid="registrationForm">
  <div class="MuiFormControl-root MuiFormControl-fullWidth css-iybwci-registrationInputContainer"><label class="MuiFormLabel-root MuiFormLabel-colorPrimary css-gpk4x8-traditionalLabel" for="firstName">First Name</label>
    <div data-testid="firstName" class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl css-1a2zu3v-traditionalInput"><input aria-invalid="false" id="firstName"
        placeholder="Enter your first name" type="text" data-testid="form-input" class="MuiInputBase-input MuiOutlinedInput-input css-1x5jdmq" value="">
      <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline css-igs3ac">
        <legend class="css-ihdtdm"><span class="notranslate">​</span></legend>
      </fieldset>
    </div>
  </div>
  <div class="MuiFormControl-root MuiFormControl-fullWidth css-iybwci-registrationInputContainer"><label class="MuiFormLabel-root MuiFormLabel-colorPrimary css-gpk4x8-traditionalLabel" for="lastName">Last Name</label>
    <div data-testid="lastName" class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl css-1a2zu3v-traditionalInput"><input aria-invalid="false" id="lastName"
        placeholder="Enter your last name" type="text" data-testid="form-input" class="MuiInputBase-input MuiOutlinedInput-input css-1x5jdmq" value="">
      <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline css-igs3ac">
        <legend class="css-ihdtdm"><span class="notranslate">​</span></legend>
      </fieldset>
    </div>
  </div>
  <div class="MuiFormControl-root MuiFormControl-fullWidth css-iybwci-registrationInputContainer"><label class="MuiFormLabel-root MuiFormLabel-colorPrimary css-gpk4x8-traditionalLabel" for="email">Email Address</label>
    <div data-testid="email" class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl css-1a2zu3v-traditionalInput"><input aria-invalid="false" id="email"
        placeholder="Please enter your professional email" type="email" data-testid="form-input" class="MuiInputBase-input MuiOutlinedInput-input css-1x5jdmq" value="">
      <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline css-igs3ac">
        <legend class="css-ihdtdm"><span class="notranslate">​</span></legend>
      </fieldset>
    </div>
  </div>
  <div class="MuiFormControl-root css-1n376y3-registrationDropdownContainer"><label class="MuiFormLabel-root MuiFormLabel-colorPrimary css-1xi87j9-dropdownInputLabel">Country</label>
    <div data-testid="country" class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-formControl css-hzshcq-traditionalInput-dropdownInputContainer">
      <div tabindex="0" role="combobox" aria-expanded="false" aria-haspopup="listbox" aria-label="Without label" class="MuiSelect-select MuiSelect-outlined MuiInputBase-input MuiOutlinedInput-input css-qiwgdb" aria-controls="mui-1">Select your
        Country</div><input aria-invalid="false" aria-hidden="true" tabindex="-1" class="MuiSelect-nativeInput css-1k3x8v3" value=""><svg class="MuiSvgIcon-root MuiSvgIcon-fontSizeMedium MuiSelect-icon MuiSelect-iconOutlined css-1636szt"
        focusable="false" aria-hidden="true" viewBox="0 0 24 24" data-testid="KeyboardArrowDownIcon">
        <path d="M7.41 8.59 12 13.17l4.59-4.58L18 10l-6 6-6-6z"></path>
      </svg>
      <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline css-igs3ac">
        <legend class="css-ihdtdm"><span class="notranslate">​</span></legend>
      </fieldset>
    </div>
  </div>
  <div class="MuiFormControl-root MuiFormControl-fullWidth css-iybwci-registrationInputContainer"><label class="MuiFormLabel-root MuiFormLabel-colorPrimary css-gpk4x8-traditionalLabel" for="state">State/Province</label>
    <div data-testid="state" class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl css-1a2zu3v-traditionalInput"><input aria-invalid="false" id="state"
        placeholder="Please enter your region/province" type="text" data-testid="form-input" class="MuiInputBase-input MuiOutlinedInput-input css-1x5jdmq" value="">
      <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline css-igs3ac">
        <legend class="css-ihdtdm"><span class="notranslate">​</span></legend>
      </fieldset>
    </div>
  </div>
  <div class="MuiFormControl-root css-1n376y3-registrationDropdownContainer"><label class="MuiFormLabel-root MuiFormLabel-colorPrimary css-1xi87j9-dropdownInputLabel">Profession</label>
    <div data-testid="profession" class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-formControl css-hzshcq-traditionalInput-dropdownInputContainer">
      <div tabindex="0" role="combobox" aria-expanded="false" aria-haspopup="listbox" aria-label="Without label" class="MuiSelect-select MuiSelect-outlined MuiInputBase-input MuiOutlinedInput-input css-qiwgdb" aria-controls="mui-2">Select your
        Profession</div><input aria-invalid="false" aria-hidden="true" tabindex="-1" class="MuiSelect-nativeInput css-1k3x8v3" value=""><svg class="MuiSvgIcon-root MuiSvgIcon-fontSizeMedium MuiSelect-icon MuiSelect-iconOutlined css-1636szt"
        focusable="false" aria-hidden="true" viewBox="0 0 24 24" data-testid="KeyboardArrowDownIcon">
        <path d="M7.41 8.59 12 13.17l4.59-4.58L18 10l-6 6-6-6z"></path>
      </svg>
      <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline css-igs3ac">
        <legend class="css-ihdtdm"><span class="notranslate">​</span></legend>
      </fieldset>
    </div>
  </div>
  <div class="MuiFormControl-root css-1n376y3-registrationDropdownContainer"><label class="MuiFormLabel-root MuiFormLabel-colorPrimary css-1xi87j9-dropdownInputLabel">Specialty</label>
    <div data-testid="specialty" class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-formControl css-hzshcq-traditionalInput-dropdownInputContainer">
      <div tabindex="0" role="combobox" aria-expanded="false" aria-haspopup="listbox" aria-label="Without label" class="MuiSelect-select MuiSelect-outlined MuiInputBase-input MuiOutlinedInput-input css-qiwgdb" aria-controls="mui-3">Select your
        Specialty</div><input aria-invalid="false" aria-hidden="true" tabindex="-1" class="MuiSelect-nativeInput css-1k3x8v3" value=""><svg class="MuiSvgIcon-root MuiSvgIcon-fontSizeMedium MuiSelect-icon MuiSelect-iconOutlined css-1636szt"
        focusable="false" aria-hidden="true" viewBox="0 0 24 24" data-testid="KeyboardArrowDownIcon">
        <path d="M7.41 8.59 12 13.17l4.59-4.58L18 10l-6 6-6-6z"></path>
      </svg>
      <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline css-igs3ac">
        <legend class="css-ihdtdm"><span class="notranslate">​</span></legend>
      </fieldset>
    </div>
  </div>
  <div>
    <div class="MuiFormControl-root css-30gmbb-registrationCheckbox"><label class="MuiFormControlLabel-root MuiFormControlLabel-labelPlacementEnd css-1jaw3da"><span
          class="MuiButtonBase-root MuiCheckbox-root MuiCheckbox-colorPrimary MuiCheckbox-sizeMedium PrivateSwitchBase-root MuiCheckbox-root MuiCheckbox-colorPrimary MuiCheckbox-sizeMedium MuiCheckbox-root MuiCheckbox-colorPrimary MuiCheckbox-sizeMedium css-1fvelau-checkBox"
          data-testid="toggle"><input class="PrivateSwitchBase-input css-1m9pwf3" type="checkbox" data-indeterminate="false"><svg class="MuiSvgIcon-root MuiSvgIcon-fontSizeMedium css-vubbuv" focusable="false" aria-hidden="true" viewBox="0 0 24 24"
            data-testid="CheckBoxOutlineBlankIcon">
            <path d="M19 5v14H5V5h14m0-2H5c-1.1 0-2 .9-2 2v14c0 1.1.9 2 2 2h14c1.1 0 2-.9 2-2V5c0-1.1-.9-2-2-2z"></path>
          </svg><span class="MuiTouchRipple-root css-w0pj6f"></span></span>
        <p class="MuiTypography-root MuiTypography-body1 css-1vq4oo6">I have read and agreed to the Terms of Use and Privacy Policy.</p>
      </label></div>
  </div><button
    class="MuiButtonBase-root MuiButton-root MuiButton-contained MuiButton-containedPrimary MuiButton-sizeMedium MuiButton-containedSizeMedium MuiButton-colorPrimary MuiButton-root MuiButton-contained MuiButton-containedPrimary MuiButton-sizeMedium MuiButton-containedSizeMedium MuiButton-colorPrimary css-95wh6a-registrationSubmitButton"
    tabindex="0" type="submit" data-testid="submit-button">Register<span class="MuiTouchRipple-root css-w0pj6f"></span></button>
</form>

Text Content

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First Name

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Specialty
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Dougall Medical | 

459 Columbus Ave., New York, NY 10024

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