www.triahealth.com Open in urlscan Pro
64.126.115.53  Public Scan

Form analysis
2 forms found in the DOM

GET #

<form method="GET" id="menu-search" action="#" style="display: none;">
  <input type="text" value="Start Typing..." onfocus="if (this.value == 'Start Typing...')this.value = '';" onblur="if (this.value == '')this.value = 'Start Typing...';" autocomplete="off">
</form>

POST /enroll

<form id="GetStartedForm" action="/enroll" method="post" novalidate="novalidate"><input name="__RequestVerificationToken" type="hidden"
    value="86xPpcrYAA_DYwoKhAh0nH-DE3FpQtzZOhgO4Huucu3Bumh7LUbdc0TIAzNLhNtOd38B5FIOdv0QUSm9LFRGJz5zTW9bUgHNZ8zgrwVBqw41" autocomplete="off">
  <div class="validation-summary-valid" data-valmsg-summary="true">
    <ul>
      <li style="display:none"></li>
    </ul>
  </div>
  <div class="t-form-row">
    <div class="t-form-field-wrap t-form-field--left">
      <div class="t-form-field">
        <label for="FirstName">First Name</label>
        <input class="text-box single-line" data-val="true" data-val-maxlength="The length of 'First Name' must be 25 characters or fewer." data-val-maxlength-max="25" data-val-required="'First Name' should not be empty." id="FirstName"
          name="FirstName" placeholder="enter your first name" required="true" type="text" value="" autocomplete="off">
      </div>
    </div>
    <div class="t-form-field-wrap t-form-field--right">
      <div class="t-form-field">
        <label for="LastName">Last Name</label>
        <input class="text-box single-line" data-val="true" data-val-maxlength="The length of 'Last Name' must be 25 characters or fewer." data-val-maxlength-max="25" data-val-required="'Last Name' should not be empty." id="LastName" name="LastName"
          placeholder="enter your last name" required="true" type="text" value="" autocomplete="off">
      </div>
    </div>
  </div>
  <div class="t-form-row">
    <div class="t-form-field-wrap">
      <div class="t-form-field">
        <label for="Email">Email Address</label>
        <input class="text-box single-line" data-val="true" data-val-email="'Email Address' is not a valid email address." data-val-required="'Email Address' should not be empty." id="Email" name="Email" placeholder="enter your email address"
          required="true" type="email" value="" autocomplete="off">
      </div>
    </div>
  </div>
  <div class="t-form-row">
    <div class="t-form-field-wrap">
      <div class="t-form-field">
        <label for="EmailConfirm">Re-enter Email Address</label>
        <input required="" class="" id="EmailConfirm" name="EmailConfirm" placeholder="re-enter your email address" type="email" value="" equalto="#Email" autocomplete="off">
      </div>
    </div>
  </div>
  <div class="t-form-row">
    <div class="t-form-field-wrap t-form-field--left">
      <div class="t-form-field">
        <label for="PhoneNumber">Phone Number</label>
        <input class="text-box single-line" data-val="true" data-val-phone="Phone Number is not a valid phone number" data-val-regex="provide a proper phone number" data-val-regex-pattern="^\D?(\d{3})\D?\D?(\d{3})\D?(\d{4})$"
          data-val-required="'Phone Number' should not be empty." id="PhoneNumber" minlength="12" name="PhoneNumber" placeholder="mobile number preferred" required="true" type="tel" value="" autocomplete="off">
      </div>
    </div>
    <div class="t-form-field-wrap t-form-field--right">
      <div class="t-form-field">
        <label for="Zip">Zip Code</label>
        <input class="text-box single-line" data-val="true" data-val-maxlength="The length of 'Zip Code' must be 10 characters or fewer." data-val-maxlength-max="10" data-val-required="'Zip Code' should not be empty." id="Zip" maxlength="5"
          minlength="5" name="Zip" placeholder="enter your zip code" required="true" type="text" value="" autocomplete="off">
      </div>
    </div>
  </div>
  <div class="t-form-row">
    <div class="t-form-field-wrap">
      <div class="t-form-field">
        <label for="DobMonth">Date of Birth</label>
        <div class="t-form-dob">
          <input class="text-box single-line" data-val="true" data-val-required="'Month' should not be empty." id="DobMonth" max="12" maxlength="2" min="1" minlength="1" name="DobMonth" placeholder="mm" required="true" type="text" value=""
            autocomplete="off">
          <input class="text-box single-line" data-val="true" data-val-required="'Day' should not be empty." id="DobDay" max="31" maxlength="2" min="1" minlength="1" name="DobDay" placeholder="dd" required="true" type="text" value=""
            autocomplete="off">
          <input class="text-box single-line" data-val="true" data-val-required="'Year' should not be empty." id="DobYear" max="2100" maxlength="4" min="1900" minlength="4" name="DobYear" placeholder="yyyy" required="true" type="text" value=""
            autocomplete="off">
        </div>
      </div>
    </div>
  </div>
  <div class="t-form-row">
    <div class="t-form-field">
      <input type="submit" class="t-button" value="GET STARTED" autocomplete="off">
    </div>
  </div>
</form>

Text Content

 * ENROLL ONLINE
 * REQUEST APPOINTMENT
 * PATIENT PORTAL

 * 
 * 
 * 
 * 
 * 
 * 
 * 

 * Home
 * About
   * The Tria Difference
   * Our Leadership
   * Careers
   * Community Impact
 * Solutions
   * Pharmacy Advocate Program
   * Diabetes Management
   * RxPlan Protection Suite
   * Add-On Programs
   * Savings Analysis
 * Patients
   * Why Use Tria Health
   * FAQ
   * Medication Risk Quiz
   * S.T.O.P.
   * Testimonials
   * Submit Testimonial
   * Choose to Lose
 * Resources
   * A Case Study
   * Prescription White Paper
   * Diabetes White Paper
   * Webinars
   * Blog
   * Patient Resources
   * Subscribe
 * Contact

 * ENROLL ONLINE
 * APPOINTMENTS
 * PATIENT PORTAL



ENROLL

Confidential & Personalized Care


TELL US A LITTLE ABOUT YOURSELF.

Once you've submitted your enrollment form, you will be contacted by a Tria
Health Member Advocate to schedule your first appointment.

 * 

First Name
Last Name
Email Address
Re-enter Email Address
Phone Number
Zip Code
Date of Birth




ABOUT

Tria Health offers personalized pharmacy guidance to help companies, ACOs and
health plans reduce medical cost and improve health outcomes.

 


SOLUTIONS

 * Pharmacy Advocate Program
 * Diabetes Management
 * RxPlan Protection Suite


RESOURCES

 * Success Stories
 * FAQs
 * Patient Resources


CONTACT US

 * Careers
 * Privacy
 * Communication Policy

© Copyright 2022 by Tria Health, LLC. All Rights Reserved.
 * 
 * 
 * 
 * 
 * 

 * Home
 * About
   * The Tria Difference
   * Our Leadership
   * Careers
   * Community Impact
 * Solutions
   * Pharmacy Advocate Program
   * Diabetes Management
   * RxPlan Protection Suite
   * Add-On Programs
   * Savings Analysis
 * Patients
   * Why Use Tria Health
   * FAQ
   * Medication Risk Quiz
   * S.T.O.P.
   * Testimonials
   * Submit Testimonial
   * Choose to Lose
 * Resources
   * A Case Study
   * Prescription White Paper
   * Diabetes White Paper
   * Webinars
   * Blog
   * Patient Resources
   * Subscribe
 * Contact

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