caduceusmedical.formstack.com Open in urlscan Pro
65.9.66.120  Public Scan

Form analysis
1 forms found in the DOM

POST https://caduceusmedical.formstack.com/forms/index.php

<form id="fsForm5520921" method="post" class="StyledForm-sc-1xaj75q-0 dttcWL fsForm" action="https://caduceusmedical.formstack.com/forms/index.php" novalidate="" enctype="multipart/form-data"><input type="hidden" tabindex="-1"
    name="formstackFormSchemaVersion" value="4"><input type="hidden" tabindex="-1" name="formstackFormRendererVersion" value="master"><input type="hidden" tabindex="-1" name="form" value="5520921"><input type="hidden" tabindex="-1" name="viewkey"
    value="eYRPxJsq9g"><input type="hidden" tabindex="-1" name="password" value=""><input type="hidden" tabindex="-1" name="hidden_fields" value=""><input type="hidden" tabindex="-1" name="_submit" value="1"><input type="hidden" tabindex="-1"
    name="incomplete" value=""><input type="hidden" tabindex="-1" name="incomplete_email" value=""><input type="hidden" tabindex="-1" name="incomplete_password" value=""><input type="hidden" tabindex="-1" name="latitude" value=""><input type="hidden"
    tabindex="-1" name="longitude" value=""><input id="fsUserAgent" type="hidden" tabindex="-1" name="fsUserAgent" value="Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/119.0.6045.123 Safari/537.36">
  <div id="fsPage5520921-1" class="StyledPage-sc-15mrpfq-0 hCMMok fsPage">
    <div data-testid="section0-col1" id="fsSection0" class="StyledSection-sc-1jyjf4h-0 gcHUoI fsSection"><a id="field-anchor-154508249" tabindex="-1" aria-hidden="true"></a><span class="StyledLabel-sc-vn5hkq-0 evOLxK fsLabelVertical"
        id="label-field154508249" for="field154508249" data-testid="field-154508249">
        <div class="StyledLabelText-sc-1bsmirz-0 lnOUqW fsLabel fsRequiredLabel">Employee Name<span class="fsRequiredMarker">*</span></div>
        <div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup">
          <div class="StyledSubField-sc-1wt4t9i-0 bdsNVQ fsSubField fsNameFirst"><input autocomplete="given-name" class="StyledInput-sc-1cxwxcf-0 dDIdEu" id="field154508249-first" type="text" label="Employee Name" required="" maxlength="20"
              name="field154508249-first" data-fs-field-id="154508249" data-fs-field-name="name" data-fs-field-alias="first" value=""><label for="field154508249-first" class="StyledLabel-sc-vn5hkq-0 eOdDYB">First Name</label></div>
          <div class="StyledSubField-sc-1wt4t9i-0 bdsNVQ fsSubField fsNameLast"><input autocomplete="family-name" class="StyledInput-sc-1cxwxcf-0 dDIdEu" id="field154508249-last" type="text" label="Employee Name" required="" maxlength="20"
              name="field154508249-last" data-fs-field-id="154508249" data-fs-field-name="name" data-fs-field-alias="last" value=""><label for="field154508249-last" class="StyledLabel-sc-vn5hkq-0 eOdDYB">Last Name</label></div>
        </div>
      </span><a id="field-anchor-154508268" tabindex="-1" aria-hidden="true"></a><label class="StyledLabel-sc-vn5hkq-0 evOLxK fsLabelVertical" id="label-field154508268" for="field154508268" data-testid="field-154508268">
        <div class="StyledLabelText-sc-1bsmirz-0 lnOUqW fsLabel fsRequiredLabel">Employee Email<span class="fsRequiredMarker">*</span></div>
        <div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup">
          <div class="StyledSubField-sc-1wt4t9i-0 cfEVbD"><input id="field154508268" type="email" maxlength="" label="Employee Email" required="" autocomplete="email" class="StyledInput-sc-1cxwxcf-0 dDIdEu" name="field154508268" size="50"
              placeholder="" data-fs-field-id="154508268" data-fs-field-name="email" data-fs-field-alias="value" value=""></div>
        </div><span class="StyledSupportingText-sc-1pgm78z-0 hLcAnu fsSupporting">Organization Email Only</span>
      </label><a id="field-anchor-154508295" tabindex="-1" aria-hidden="true"></a><label class="StyledLabel-sc-vn5hkq-0 evOLxK fsLabelVertical" id="label-field154508295" for="field154508295" data-testid="field-154508295">
        <div class="StyledLabelText-sc-1bsmirz-0 lnOUqW fsLabel fsRequiredLabel">Employee Job Title<span class="fsRequiredMarker">*</span></div>
        <div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup">
          <div class="StyledSubField-sc-1wt4t9i-0 gnOLlR"><input autocomplete="on" class="StyledInput-sc-1cxwxcf-0 dDIdEu" id="field154508295" type="text" label="Employee Job Title" required="" name="field154508295" placeholder=""
              data-fs-field-id="154508295" data-fs-field-name="text" data-fs-field-alias="value" value=""></div>
        </div>
      </label><a id="field-anchor-154508298" tabindex="-1" aria-hidden="true"></a><label class="StyledLabel-sc-vn5hkq-0 evOLxK fsLabelVertical" id="label-field154508298" for="field154508298" data-testid="field-154508298">
        <div class="StyledLabelText-sc-1bsmirz-0 lnOUqW fsLabel fsRequiredLabel">Authenticate Submission<span class="fsRequiredMarker">*</span></div>
        <div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup">
          <div class="StyledSubField-sc-1wt4t9i-0 gnOLlR"><input autocomplete="on" class="StyledInput-sc-1cxwxcf-0 dDIdEu" id="field154508298" type="text" label="Authenticate Submission" required="" name="field154508298" placeholder=""
              data-fs-field-id="154508298" data-fs-field-name="text" data-fs-field-alias="value" value=""></div>
        </div><span class="StyledSupportingText-sc-1pgm78z-0 hLcAnu fsSupporting">Enter your password correctly to successfully authenticate submission</span>
      </label><a id="field-anchor-154473572" tabindex="-1" aria-hidden="true"></a><span class="StyledLabel-sc-vn5hkq-0 evOLxK fsLabelVertical" id="label-field154473572" for="field154473572" data-testid="field-154473572-vertical">
        <div class="StyledLabelText-sc-1bsmirz-0 lnOUqW fsLabel fsRequiredLabel">I agree and comply that all the information entered is correctly<span class="fsRequiredMarker">*</span></div>
        <fieldset aria-labelledby="154473572-legend" role="group" class="StyledFieldset-sc-1r8yz9c-0 StyledOptionWrapper-sc-1ah0fdf-0 cdlqHK PSYyM"><span style="position: absolute; left: -999em; width: 0.1em; height: 0.1em; overflow: hidden;">
            <legend id="154473572-legend">I agree and comply that all the information entered is correctly Required field</legend>
          </span>
          <div><label for="field154473572_1" class="StyledOptionLabel-sc-1bymt4x-0 czQxLs fsOptionLabel"><input label="I agree and comply that all the information entered is correctly" required="" name="field154473572[]"
                class="StyledOptionButton-sc-wqe0tc-0 ezuKZu" type="checkbox" id="field154473572_1" data-fs-field-id="154473572" data-fs-field-name="checkbox" data-fs-field-alias="0" value="YES">YES</label></div>
        </fieldset>
      </span></div>
  </div>
  <div id="fsSubmit5520921" class="StyledFormFooter-sc-9cjpwp-0 dPhaIv fsSubmit fsPagination">
    <div class="StyledFormNavigations-sc-t0vu6u-0 jnnwJH"><button id="fsSubmitButton5520921" class="StyledSubmitButton-sc-1ylq3c5-0 cfDACd fsSubmitButton" type="submit">Submit Form</button></div>
  </div>
</form>

Text Content

Welcome

Employee Name*
First Name
Last Name
Employee Email*

Organization Email Only
Employee Job Title*

Authenticate Submission*

Enter your password correctly to successfully authenticate submission
I agree and comply that all the information entered is correctly*
I agree and comply that all the information entered is correctly Required field
YES
Submit Form