ophtaview.programari.cloud.onlineservice.io Open in urlscan Pro
35.180.237.2  Public Scan

Form analysis
1 forms found in the DOM

POST

<form method="post" id="form" target="hiddenFrame" style="padding-top: 50px;">
  <input type="hidden" name="_token" value="nfNyGyjnvDCUcW7rbRqDxWd7A4eapcjo885HaagQ">
  <div class="container-fluid" style="padding: 25px 20px">
    <div class="row mb-4">
      <div class="col-md-12">
        <a href="https://www.ophtaview.ro/"><img style="margin-right: 30px; width: 256px;" src="https://www.ophtaview.ro/wp-content/uploads/2023/05/cropped-Ophta-View-2023.jpg"></a>
        <a href="https://www.ophtaview.ro/" class="btn  back-to-site focus_button"> <i class="fa fa-chevron-left" style="padding-right: 5px"></i>Inapoi  in site</a>
      </div>
    </div>
  </div>
  <div class="container-fluid" id="page1">
    <div class="row mb-4">
      <!--            <div class="col-12">-->
      <!--                <div class="alert alert-danger" role="alert"></div>-->
      <!--            </div>-->
      <div class="form-group col-md-6 col-lg-3">
        <label for="doctor_id"><strong>1. Alege medicul</strong></label>
        <div class="d-flex">
          <input type="hidden" id="doctor_type" value="2">
        </div>
        <div class="dropdown bootstrap-select"><select class="selectpicker" id="doctor_id" name="doctor_id" tabindex="-98">
            <!--                    <option selected>Alege</option>-->
          </select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="combobox" aria-owns="bs-select-1" aria-haspopup="listbox" aria-expanded="false" data-id="doctor_id" title="Alege">
            <div class="filter-option">
              <div class="filter-option-inner">
                <div class="filter-option-inner-inner">Alege</div>
              </div>
            </div>
          </button>
          <div class="dropdown-menu " style="max-height: 753px; overflow: hidden; min-height: 0px;">
            <div class="inner show" role="listbox" id="bs-select-1" tabindex="-1" style="max-height: 751px; overflow-y: auto; min-height: 0px;">
              <ul class="dropdown-menu inner show" role="presentation"></ul>
            </div>
          </div>
        </div>
      </div>
      <div class="form-group col-md-1 col-lg-1"></div>
      <div class="form-group col-md-12 col-lg-4">
        <label for="date"><strong>2. Alege data</strong></label>
        <div class="d-flex">
          <div class="custom-control custom-radio">
          </div>
          <div class="custom-control custom-radio">
            <br>
          </div>
        </div>
        <div class="datepicker" name="date">
          <input type="hidden" id="datepicker" name="date1" value="">
          <div class="datepicker datepicker-inline">
            <div class="datepicker-days" style="">
              <table class="table-condensed">
                <thead>
                  <tr>
                    <th colspan="7" class="datepicker-title" style="display: none;"></th>
                  </tr>
                  <tr>
                    <th class="prev disabled">«</th>
                    <th colspan="5" class="datepicker-switch">Ianuarie 2024</th>
                    <th class="next">»</th>
                  </tr>
                  <tr>
                    <th class="dow">Lu</th>
                    <th class="dow">Ma</th>
                    <th class="dow">Mi</th>
                    <th class="dow">Jo</th>
                    <th class="dow">Vi</th>
                    <th class="dow disabled">Sâ</th>
                    <th class="dow">Du</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td class="old disabled day disabled" data-date="1703462400000">25</td>
                    <td class="old disabled day disabled" data-date="1703548800000">26</td>
                    <td class="old disabled day disabled" data-date="1703635200000">27</td>
                    <td class="old disabled day disabled" data-date="1703721600000">28</td>
                    <td class="old disabled day disabled" data-date="1703808000000">29</td>
                    <td class="old disabled disabled-date day disabled" data-date="1703894400000">30</td>
                    <td class="old disabled disabled-date day disabled" data-date="1703980800000">31</td>
                  </tr>
                  <tr>
                    <td class="disabled day disabled" data-date="1704067200000">1</td>
                    <td class="disabled day disabled" data-date="1704153600000">2</td>
                    <td class="disabled day disabled" data-date="1704240000000">3</td>
                    <td class="disabled day disabled" data-date="1704326400000">4</td>
                    <td class="disabled day disabled" data-date="1704412800000">5</td>
                    <td class="disabled disabled-date day disabled" data-date="1704499200000">6</td>
                    <td class="disabled disabled-date day disabled" data-date="1704585600000">7</td>
                  </tr>
                  <tr>
                    <td class="disabled day disabled" data-date="1704672000000">8</td>
                    <td class="disabled day disabled" data-date="1704758400000">9</td>
                    <td class="disabled day disabled" data-date="1704844800000">10</td>
                    <td class="disabled day disabled" data-date="1704931200000">11</td>
                    <td class="disabled day disabled" data-date="1705017600000">12</td>
                    <td class="disabled disabled-date day disabled" data-date="1705104000000">13</td>
                    <td class="disabled disabled-date day disabled" data-date="1705190400000">14</td>
                  </tr>
                  <tr>
                    <td class="disabled day disabled" data-date="1705276800000">15</td>
                    <td class="disabled day disabled" data-date="1705363200000">16</td>
                    <td class="disabled day disabled" data-date="1705449600000">17</td>
                    <td class="disabled day disabled" data-date="1705536000000">18</td>
                    <td class="disabled day disabled" data-date="1705622400000">19</td>
                    <td class="disabled disabled-date day disabled" data-date="1705708800000">20</td>
                    <td class="disabled disabled-date day disabled" data-date="1705795200000">21</td>
                  </tr>
                  <tr>
                    <td class="disabled day disabled" data-date="1705881600000">22</td>
                    <td class="disabled day disabled" data-date="1705968000000">23</td>
                    <td class="disabled day disabled" data-date="1706054400000">24</td>
                    <td class="disabled day disabled" data-date="1706140800000">25</td>
                    <td class="disabled day disabled" data-date="1706227200000">26</td>
                    <td class="disabled disabled-date day disabled" data-date="1706313600000">27</td>
                    <td class="disabled disabled-date day disabled" data-date="1706400000000">28</td>
                  </tr>
                  <tr>
                    <td class="disabled day disabled" data-date="1706486400000">29</td>
                    <td class="disabled day disabled" data-date="1706572800000">30</td>
                    <td class="today day disabled" data-date="1706659200000">31</td>
                    <td class="new day disabled" data-date="1706745600000">1</td>
                    <td class="new day disabled" data-date="1706832000000">2</td>
                    <td class="new disabled disabled-date day disabled" data-date="1706918400000">3</td>
                    <td class="new disabled disabled-date day disabled" data-date="1707004800000">4</td>
                  </tr>
                </tbody>
                <tfoot>
                  <tr>
                    <th colspan="7" class="today" style="display: none;">Astăzi</th>
                  </tr>
                  <tr>
                    <th colspan="7" class="clear" style="display: none;">Șterge</th>
                  </tr>
                </tfoot>
              </table>
            </div>
            <div class="datepicker-months" style="display: none;">
              <table class="table-condensed">
                <thead>
                  <tr>
                    <th colspan="7" class="datepicker-title" style="display: none;"></th>
                  </tr>
                  <tr>
                    <th class="prev disabled">«</th>
                    <th colspan="5" class="datepicker-switch">2024</th>
                    <th class="next">»</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td colspan="7"><span class="month focused">Ian</span><span class="month">Feb</span><span class="month">Mar</span><span class="month">Apr</span><span class="month">Mai</span><span class="month">Iun</span><span
                        class="month">Iul</span><span class="month">Aug</span><span class="month">Sep</span><span class="month">Oct</span><span class="month">Nov</span><span class="month">Dec</span></td>
                  </tr>
                </tbody>
                <tfoot>
                  <tr>
                    <th colspan="7" class="today" style="display: none;">Astăzi</th>
                  </tr>
                  <tr>
                    <th colspan="7" class="clear" style="display: none;">Șterge</th>
                  </tr>
                </tfoot>
              </table>
            </div>
            <div class="datepicker-years" style="display: none;">
              <table class="table-condensed">
                <thead>
                  <tr>
                    <th colspan="7" class="datepicker-title" style="display: none;"></th>
                  </tr>
                  <tr>
                    <th class="prev disabled">«</th>
                    <th colspan="5" class="datepicker-switch">2020-2029</th>
                    <th class="next">»</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td colspan="7"><span class="year old disabled">2019</span><span class="year disabled">2020</span><span class="year disabled">2021</span><span class="year disabled">2022</span><span class="year disabled">2023</span><span
                        class="year focused">2024</span><span class="year">2025</span><span class="year">2026</span><span class="year">2027</span><span class="year">2028</span><span class="year">2029</span><span class="year new">2030</span></td>
                  </tr>
                </tbody>
                <tfoot>
                  <tr>
                    <th colspan="7" class="today" style="display: none;">Astăzi</th>
                  </tr>
                  <tr>
                    <th colspan="7" class="clear" style="display: none;">Șterge</th>
                  </tr>
                </tfoot>
              </table>
            </div>
            <div class="datepicker-decades" style="display: none;">
              <table class="table-condensed">
                <thead>
                  <tr>
                    <th colspan="7" class="datepicker-title" style="display: none;"></th>
                  </tr>
                  <tr>
                    <th class="prev disabled">«</th>
                    <th colspan="5" class="datepicker-switch">2000-2090</th>
                    <th class="next">»</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td colspan="7"><span class="decade old disabled">1990</span><span class="decade disabled">2000</span><span class="decade disabled">2010</span><span class="decade disabled focused">2020</span><span class="decade">2030</span><span
                        class="decade">2040</span><span class="decade">2050</span><span class="decade">2060</span><span class="decade">2070</span><span class="decade">2080</span><span class="decade">2090</span><span class="decade new">2100</span>
                    </td>
                  </tr>
                </tbody>
                <tfoot>
                  <tr>
                    <th colspan="7" class="today" style="display: none;">Astăzi</th>
                  </tr>
                  <tr>
                    <th colspan="7" class="clear" style="display: none;">Șterge</th>
                  </tr>
                </tfoot>
              </table>
            </div>
            <div class="datepicker-centuries" style="display: none;">
              <table class="table-condensed">
                <thead>
                  <tr>
                    <th colspan="7" class="datepicker-title" style="display: none;"></th>
                  </tr>
                  <tr>
                    <th class="prev disabled">«</th>
                    <th colspan="5" class="datepicker-switch">2000-2900</th>
                    <th class="next">»</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td colspan="7"><span class="century old disabled">1900</span><span class="century disabled focused">2000</span><span class="century">2100</span><span class="century">2200</span><span class="century">2300</span><span
                        class="century">2400</span><span class="century">2500</span><span class="century">2600</span><span class="century">2700</span><span class="century">2800</span><span class="century">2900</span><span
                        class="century new">3000</span></td>
                  </tr>
                </tbody>
                <tfoot>
                  <tr>
                    <th colspan="7" class="today" style="display: none;">Astăzi</th>
                  </tr>
                  <tr>
                    <th colspan="7" class="clear" style="display: none;">Șterge</th>
                  </tr>
                </tfoot>
              </table>
            </div>
          </div>
        </div>
      </div>
      <div class="form-group col-md-1 col-lg-1"></div>
      <div class="form-group col-md-6 col-lg-3">
        <label for="hour"><strong>3. Alege ora</strong></label>
        <input type="hidden" name="hour" id="hour" value="">
        <div class="d-flex">
          <div class="custom-control custom-radio">
          </div>
          <div class="custom-control custom-radio">
            <br>
          </div>
        </div>
        <div id="clinic_time" class="btn-group-toggle" data-toggle="buttons"></div>
      </div>
    </div>
    <div class="bottom-info row">
      <div id="info" class="col-md-4 col-sm-12">
        <span id="doctor_info"></span><br>
        <span id="data_info"></span><br>
      </div>
      <input id="info_data" type="hidden" name="info_data" class="col-md-4 col-sm-12">
      <div class="col-md-4 col-sm-12">
        <button type="button" id="button1" class="focus_button"><span class="span1">Programeaza-te</span></button>
      </div>
    </div>
  </div>
  <div class="container-fluid" id="page2" style="display: none;">
    <h2>Date personale</h2>
    <div id="patient_info" class="row mb-4" style="padding-bottom: 105px">
      <div class="col-12">
        <div class="alert alert-danger" role="alert" style="display: none;">
          <strong>Programarea nu a putut fi salvata</strong> Va rugam reincercati!
        </div>
        <div class="alert alert-warning" role="alert" style="color: red; display: none;">
          <strong>Intervalul orar ales a fost ocupat!</strong> Va rugam sa alegeti alt interval!
        </div>
      </div>
      <div class="form-group col-md-3">
        <label for="surname">Prenume</label>
        <input type="text" class="form-control" id="surname" name="surname">
      </div>
      <div class="form-group col-md-3">
        <label for="name">Nume</label>
        <input type="text" class="form-control" id="name" name="name">
      </div>
      <div class="form-group col-md-3">
        <label for="cnp">CNP</label>
        <input type="text" class="form-control" id="cnp" name="cnp">
      </div>
      <div class="form-group col-md-6">
        <label for="email">Email</label>
        <input type="email" class="form-control" id="email" name="email">
      </div>
      <div class="form-group col-md-6">
        <label for="phone">Telefon (07XX XXX XXX)</label>
        <input type="tel" class="form-control" id="phone" name="phone" data-inputmask="'mask': '9999999999'">
      </div>
      <div class="form-group col-md-6">
        <label for="birthday">Data nasterii (ZZ/LL/AAAA)</label>
        <!--                <input type="text" class=" form-control" id="birthday" name="birthday" data-inputmask="'alias': 'date'">-->
        <div>
          <input class="form-control" required="" id="birthday" name="birthday" type="text" data-inputmask="'alias': 'date'">
        </div>
      </div>
      <div class="form-group col-md-3">
        <label for="nr_card">Cod abonat/Reducere</label>
        <input type="text" class="form-control" id="nr_card" name="nr_card">
      </div>
      <div class="form-group col-md-7">
        <label for="gdpr" class="checkbox-container pull-left"> Sunt de acord cu Politica de confidentialitate <input type="checkbox" id="gdpr" name="gdpr">
          <span class="checkmark"></span>
        </label>
      </div>
    </div>
    <div class="bottom-info row">
      <div id="info1">
        <span id="doctor_info1"></span><br>
        <span id="data_info1"></span><br>
      </div>
      <div style="" id="div_back">
        <button type="button" id="back" class="focus_button"><span class="span1">Inapoi</span></button>
      </div>
      <div>
        <button type="submit" id="button2" class="focus_button"><span class="span1">Programeaza-te</span></button>
      </div>
    </div>
  </div>
  <div class="container-fluid" role="alert" id="page3" style="display: none;">
    <div class="row mb-4" style="height: 355px">
      <div style="margin-top: 70px; margin-left: 80px" align="center">
        <center>
          <h1 style="color:#1771CE;" align="center"><strong>Programarea a fost înregistrată cu succes, ai confirmarea pe email.<br> Mulțumim pentru încredere!</strong></h1>
        </center>
      </div>
    </div>
    <div class="bottom-info row">
      <div id="info2">
        <span id="doctor_info2"></span><br>
        <span id="data_info2"></span><br>
      </div>
    </div>
  </div>
</form>

Text Content

Inapoi in site
1. Alege medicul

Alege


2. Alege data



«Ianuarie
2024»LuMaMiJoViSâDu25262728293031123456789101112131415161718192021222324252627282930311234AstăziȘterge

«2024»IanFebMarAprMaiIunIulAugSepOctNovDecAstăziȘterge

«2020-2029»201920202021202220232024202520262027202820292030AstăziȘterge

«2000-2090»199020002010202020302040205020602070208020902100AstăziȘterge

«2000-2900»190020002100220023002400250026002700280029003000AstăziȘterge


3. Alege ora






Programeaza-te


DATE PERSONALE

Programarea nu a putut fi salvata Va rugam reincercati!
Intervalul orar ales a fost ocupat! Va rugam sa alegeti alt interval!
Prenume
Nume
CNP
Email
Telefon (07XX XXX XXX)
Data nasterii (ZZ/LL/AAAA)

Cod abonat/Reducere
Sunt de acord cu Politica de confidentialitate



Inapoi
Programeaza-te


PROGRAMAREA A FOST ÎNREGISTRATĂ CU SUCCES, AI CONFIRMAREA PE EMAIL.
MULȚUMIM PENTRU ÎNCREDERE!