crm.bestnotes.com
Open in
urlscan Pro
34.173.124.86
Public Scan
URL:
https://crm.bestnotes.com/portal/yhmt
Submission: On July 06 via manual from US — Scanned from DE
Submission: On July 06 via manual from US — Scanned from DE
Form analysis
2 forms found in the DOMName: LOGIN — POST
<form id="LOGIN" name="LOGIN" method="post" style="margin:0px;">
<input type="hidden" name="csrf_token" value="EpbhFS7z7bFXw27euJaUwnYeXGCBzAFZqp94_8JQ74Y">
<table style="width: 100%; margin-top: 5px;">
<tbody>
<tr>
<td class="labelcell">
<label for="LUID">User ID (email):</label>
</td>
<td class="contentcell">
<input class="grayborder" type="text" style="width: 238px;" id="LUID" name="LUID" value="" onchange="trimFieldValue(this)">
</td>
</tr>
<tr>
<td class="labelcell">
<label for="LPWD">Password:</label>
</td>
<td class="contentcell">
<input class="grayborder" autocomplete="off" type="password" style="width: 238px;" id="LPWD" name="LPWD">
</td>
</tr>
<tr>
<td colspan="2" style="padding-top: 20px;" align="center">
<input class="button" type="submit" value="Log In" style="width: 80px;" onclick="auth()">
<br>
<br>
<a href="" onclick="forgot(); return false;" title="Click to reset your password">Forgot your password?</a><br>
<div id="errormsg" align="center" style="color: red; font-weight: bold;"> </div>
</td>
</tr>
</tbody>
</table>
<input type="hidden" name="NPW" id="NPW" value="">
</form>
Name: NEWAPPLICANT — POST
<form id="NEWAPPLICANT" name="NEWAPPLICANT" method="POST">
<input type="hidden" name="csrf_token" value="EpbhFS7z7bFXw27euJaUwnYeXGCBzAFZqp94_8JQ74Y">
<table style="width: 100%; margin-top: 5px;">
<tbody>
<tr>
<td class="labelcell" style="vertical-align: top;">
<label for="FNAME">Your First Name:</label>
</td>
<td class="contentcell">
<input class="grayborder" type="text" style="width: 200px;" id="FNAME" name="FNAME" value="" onchange="trimFieldValue(this)">
</td>
</tr>
<tr>
<td class="labelcell" style="vertical-align: top;">
<label for="LNAME">Last Name:</label>
</td>
<td class="contentcell">
<input class="grayborder" type="text" style="width: 200px;" id="LNAME" name="LNAME" value="" onchange="trimFieldValue(this)">
</td>
</tr>
<tr>
<td class="labelcell">
<label for="USERID">User ID (email):</label>
</td>
<td class="contentcell">
<input class="grayborder" type="text" style="width: 200px;" id="USERID" name="USERID" value="" onchange="trimFieldValue(this)">
</td>
</tr>
<tr>
<td class="labelcell" style="padding-bottom: 10px;">
<label for="CONFIRMUSER">Confirm:</label>
</td>
<td class="contentcell" style="padding-bottom: 10px;">
<input class="grayborder" type="text" style="width: 200px;" autocomplete="off" id="CONFIRMUSER" name="CONFIRMUSER" value="" onchange="trimFieldValue(this)">
</td>
</tr>
<tr>
<td class="labelcell">
<label for="PASSWORD">Password:</label>
</td>
<td class="contentcell">
<input class="grayborder" autocomplete="off" type="password" style="width: 200px;" id="PASSWORD" name="PASSWORD" value="">
<img alt="reply button" style="position:absolute;margin:5px;display:inline-block;"
onclick="alert('Password needs to be at least 8 characters long. Password must contain uppercase, lowercase letters, numbers and special characters.');"
title="Password needs to be at least 8 characters long. Password must contain uppercase, lowercase letters, numbers and special characters." src="/crmbeta/images/help.png">
</td>
</tr>
<tr>
<td class="labelcell">
<label for="CONFIRMPASSWORD">Confirm:</label>
</td>
<td class="contentcell">
<input class="grayborder" autocomplete="off" type="password" style="width: 200px;" id="CONFIRMPASSWORD" name="CONFIRMPASSWORD" value="">
</td>
</tr>
<!--<tr>
<td colspan="2" align="right" style="padding-top: 10px;">Security Question: <input type="text" name="QUESTION" style="width: 235px;" value=""></td>
</tr>
<tr>
<td class="labelcell">Answer:</td>
<td class="contentcell"><input type="text" name="ANSWER" style="width: 238px;"></td>
</tr>-->
<tr>
<td colspan="2" style="padding-top: 20px;" align="center">
<input id="createPortalAccount" class="button" type="button" value="Create Account" onclick="submitNew(); return false;">
<input id="termsCondsChecked" type="hidden" name="termsCondsChecked" value="0">
<input id="termsCondsVersion" type="hidden" name="termsCondsVersion" value="V1.0">
</td>
</tr>
</tbody>
</table>
<div id="termsCondsPopup">
<div class="termsCondsContent">
<iframe id="termsCondsContentIFrame" src="/terms/terms/V1.0.html" frameborder="0"></iframe>
</div>
<div class="termsCondsCheck">
<input type="checkbox" name="termsCondsAgree" id="termsCondsAgree" style="vertical-align: middle"> I agree to the terms of use <input id="cancelPortalAccount" class="button" type="button" value="Cancel"
onclick="cancelTermsDialogBox('signup');">
<input id="createPortalAccountTerms" class="button termsFloatRight" type="button" value="Continue" onclick="submitNew(); return false;">
</div>
</div>
<style>
#termsCondsContentIFrame {
margin: 0;
width: 100%;
height: 100%;
}
#termsCondsPopup {
display: none;
margin: 0 auto;
}
.termsCondsContent {
height: 520px !important;
}
.termsCondsCheck {
border-top: 1px solid gray;
margin-top: 5px;
padding: 10px 0;
}
#cancelPortalAccount {
float: right;
margin-left: 10px;
}
.termsFloatRight {
float: right;
}
</style>
<script>
// function to close the Terms popup
function cancelTermsDialogBox(action) {
jQuery('#termsCondsPopup').dialog('close');
jQuery('#termsCondsPopup').dialog('destroy');
jQuery('#createPortalAccount').removeAttr('disabled');
// if FORM action is create account, then on cancel make checkbox and button disabled so that user can again see popup with disable button
if (action == 'signup') {
jQuery('#termsCondsAgree').prop('checked', false);
}
}
// function to open the Terms popup
function openTermsDialogBox() {
jQuery('#termsCondsPopup').dialog('destroy');
var termsCondsVersion = jQuery('#termsCondsVersion').val();
var termsCondsCreatedDate = jQuery('#termsCondsCreatedDate').val();
jQuery('#termsCondsPopup').dialog({
autoOpen: false,
minHeight: 0,
width: 780,
modal: true,
resizable: false,
title: 'Patient Portal Terms Of Use - ' + termsCondsVersion + ' - Last updated: ' + termsCondsCreatedDate,
position: ['center', 10],
open: function() {
jQuery(this).closest('.ui-dialog').find('.ui-dialog-titlebar-close').removeClass('ui-dialog-titlebar-close').html('')
},
close: function(a, ui) {
jQuery('#termsCondsPopup').dialog('destroy');
}
});
jQuery('#termsCondsPopup').dialog('open');
}
// if user click on submit button, validate if terms agree checkbox checked
// if yes, post the form data and save to DB
function submitTermsConds() {
if (jQuery('#termsCondsPopup').css('display') == 'block') {
if (!jQuery('#termsCondsAgree').is(':checked')) {
alert('Please indicate that you have read and agree to the Terms of Use');
return false;
}
}
var postvars = Form.serialize('userTermsCondsForm');
postvars += "&csrf_token=" + csrf_token;
var postData = {
url: 'update_fields.php',
type: 'POST',
async: false,
data: postvars,
dataType: "json",
success: function(response) {
if (response.error) {
alert(response.error);
return;
}
if (response && response.redirectToMainMenu) {
if (response.alert) {
alert(response.alert);
}
document.location = rooturl + "menu";
success = false;
preventConnectionErrorPopup = true;
}
document.location = document.location;
}
};
jQuery.ajax(postData);
return success;
}
</script>
</form>
Text Content
Saving. Please Wait... Portal LOGIN Login to existing account: Create a new account: User ID (email): Password: Forgot your password? Your First Name: Last Name: User ID (email): Confirm: Password: Confirm: I agree to the terms of use By using the Portal you agree to the Terms of Use. Saving. Please Wait...