drballyhoo.com Open in urlscan Pro
104.225.251.135  Public Scan

Form analysis
3 forms found in the DOM

<form id="loginform">
  <div class="prompt_group">
    <div class="prompt">E-Mail:</div>
    <div class="prompt_data"><input type="text" name="email"></div>
  </div>
  <div class="prompt_group">
    <div class="prompt">Password:</div>
    <div class="prompt_data"><input type="password" name="password"></div>
  </div>
  <div class="window_button"><button type="button" onclick="loginRequest();">Log In</button></div>
  <div id="message" class="message"></div>
</form>

<form id="registerform">
  <div class="prompt_group">
    <div class="prompt">E-Mail:</div>
    <div class="prompt_data"><input type="text" name="email"></div>
  </div>
  <div class="prompt_group">
    <div class="prompt">Provider Name:</div>
    <div class="prompt_data"><input type="text" name="provider"></div>
  </div>
  <div class="prompt_group">
    <div class="prompt">Password:</div>
    <div class="prompt_data"><input type="password" name="password"></div>
  </div>
  <div class="prompt_group">
    <div class="prompt">Verify Password:</div>
    <div class="prompt_data"><input type="password" name="verify"></div>
  </div>
  <div class="window_button"><button type="button" onclick="registerRequest();">Register</button></div>
  <div id="message2" class="message"></div>
  <div class="window_text">To return to login <a onclick="selectPage('login')">click here</a>.</div>
</form>

<form id="uploadFileData" enctype="multipart/form-data">
  <div class="window_text">You can print a logo on the treatment sheets by uploading it here.</div>
  <div class="prompt_data"><input type="file" id="file" name="logo_data"></div>
  <div class="window_button"><button type="button" onclick="uploadImage();">Upload Image</button></div>
  <div id="message3" class="message"></div>
  <div><img id="headingImage" class="heading_image"></div>
</form>

Text Content

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DR. BALLYHOO

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CONTACT US
LOGIN

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This is the website where you put all the stuff to sell Dr. Ballyhoo's services.

Use Dr. Ballyhoo to print highly specialized treatment notes to your patient for
improved treatment quality.

Improve access to your favorite rating services to get your rating counts up.

Privacy Policy

Terms and Conditions

This is the login for Dr. Ballyhoo.
E-Mail:

Password:

Log In

Or if you do not have an account, please register.
Register
If you have an account but have forgotten your password, click here.


DR. BALLYHOO ACCOUNT REGISTRATION

Enter the following information:
E-Mail:

Provider Name:

Password:

Verify Password:

Register

To return to login click here.
Check your e-mail to find an e-mail verification request and click the button on
the e-mail.
If you do not see it, please check your spam. You may make another request by
pressing the button.
Resend Verification E-Mail


PAYMENT OPTIONS

Select the payment period you would like to purchase:
Free 30 day trial
$30 Monthly Billed
$300 Annualy Billed

Start Trial

Thank you for your payment!
A receipt has been sent to your e-mail. You can also print this page as a
receipt if you did not receive one.
Place receipt data here.
Proceed to account.


ACCOUNT INFORMATION

Provider:



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USER LOGINS

You can add users to this account that will be allowed to generate the treatment
sheets for patients.

Added users will receive an email confirming the email address and providing a
link to set their passwords.

Add User

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PAYMENT STATUS


Make Payment

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CUSTOM HEADING IMAGE

You can print a logo on the treatment sheets by uploading it here.

Upload Image



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Diagnosis

Back


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