survey3.medallia.com Open in urlscan Pro
147.75.243.92  Public Scan

Form analysis
1 forms found in the DOM

Name: surveyform — POST /?ewhbxr3zssw3b68hmvb9

<form name="surveyform" action="/?ewhbxr3zssw3b68hmvb9" method="post"><!-- react-empty: 4 -->
  <div><!-- react-empty: 6 --><input type="hidden" name="is_embedded" id="is_embedded" value="false">
    <header><a class="layout_skipNav" href="#content">Skip to Content</a>
      <div class="layout_layoutContainer">
        <div class="layout_mainHeader layout_clearfix">
          <div class="layout_mainHeaderLeft">
            <h1 class="layout_invisibleTitle" tabindex="0" aria-label="Survey"></h1><img id="pageLogo" class="layout_logo" src="https://sea1.cdn.survey.medallia.com/61c3e818262fed924cfad5f0c26f30164bebc8d2" alt="Page_logo">
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          <div class="layout_mainHeaderRight"><span id="languageSelector" class=""><!-- react-empty: 17 --><input type="hidden" name="lang" id="activeLang" value="en"></span></div>
        </div>
      </div>
    </header>
    <div class="layout_layoutContainer"><input type="hidden" name="stay_main-pager" value="0"><input type="hidden" name="nodeId" value="survey3-fe3"><input type="hidden" name="ballotVer" value="27"><input type="hidden" name="currentPage"
        value="0"><input type="hidden" name="defPgrAction" value="next"><!-- react-empty: 25 --></div>
    <div role="main" id="content" class="layout_layoutContainer layout_layoutContainer_fadeInUp">
      <fieldset class="questionBlock ratingGridQuestion ratingGridQuestion_hasOneRow">
        <legend class="question_questionTitle" id="0"><span class="validation_validationBlock validationMessage validation_requiredBlock"><i aria-hidden="true" class="medallicons_medallicons validation_validationIcon"></i><span
              class="validation_caption">Required</span></span><span class="questionCaption">How satisfied are you with the service provided during your request for coverage?</span></legend>
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                    <div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_11column anchor_isJustified anchor_isOnFirstRow"><span id="anchor_0_0">Not At All Satisfied</span></div>
                    <div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_11column anchor_isJustified anchor_isOnFirstRow"><span id="anchor_0_1">Extremely Satisfied</span></div>
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                            aria-describedby="0 0_onf_q_pru_gi_eoi_osat_scale11___vvmVeB" aria-label="0 Not At All Satisfied" class="cellOption_input" data-mds-value="0" data-representative-value="0" name="onf_q_pru_gi_eoi_osat_scale11" value="0">
                          <div aria-hidden="true" class="cellOption_indicatorContainer">
                            <div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
                              <div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">0</span>
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                            aria-describedby="0 0_onf_q_pru_gi_eoi_osat_scale11___vvmVeB" aria-label="1 Not At All Satisfied" class="cellOption_input" data-mds-value="1" data-representative-value="1" name="onf_q_pru_gi_eoi_osat_scale11" value="1">
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                            <div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
                              <div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">1</span>
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                            aria-describedby="0 0_onf_q_pru_gi_eoi_osat_scale11___vvmVeB" aria-label="2" class="cellOption_input" data-mds-value="2" data-representative-value="2" name="onf_q_pru_gi_eoi_osat_scale11" value="2">
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                            <div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
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                            <div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
                              <div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">3</span>
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                      <div class="cell_cell selectionBar_selectionUnit layout_answer">
                        <div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_pru_gi_eoi_osat_scale11_4" aria-required="true"
                            aria-describedby="0 0_onf_q_pru_gi_eoi_osat_scale11___vvmVeB" aria-label="4" class="cellOption_input" data-mds-value="4" data-representative-value="4" name="onf_q_pru_gi_eoi_osat_scale11" value="4">
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                            <div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
                              <div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">4</span>
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                      <div class="cell_cell selectionBar_selectionUnit layout_answer">
                        <div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_pru_gi_eoi_osat_scale11_5" aria-required="true"
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                            <div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
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                      <div class="cell_cell selectionBar_selectionUnit layout_answer">
                        <div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_pru_gi_eoi_osat_scale11_6" aria-required="true"
                            aria-describedby="0 0_onf_q_pru_gi_eoi_osat_scale11___vvmVeB" aria-label="6" class="cellOption_input" data-mds-value="6" data-representative-value="6" name="onf_q_pru_gi_eoi_osat_scale11" value="6">
                          <div aria-hidden="true" class="cellOption_indicatorContainer">
                            <div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
                              <div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">6</span>
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                      <div class="cell_cell selectionBar_selectionUnit layout_answer">
                        <div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_pru_gi_eoi_osat_scale11_7" aria-required="true"
                            aria-describedby="0 0_onf_q_pru_gi_eoi_osat_scale11___vvmVeB" aria-label="7" class="cellOption_input" data-mds-value="7" data-representative-value="7" name="onf_q_pru_gi_eoi_osat_scale11" value="7">
                          <div aria-hidden="true" class="cellOption_indicatorContainer">
                            <div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
                              <div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">7</span>
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                      <div class="cell_cell selectionBar_selectionUnit layout_answer">
                        <div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_pru_gi_eoi_osat_scale11_8" aria-required="true"
                            aria-describedby="0 0_onf_q_pru_gi_eoi_osat_scale11___vvmVeB" aria-label="8" class="cellOption_input" data-mds-value="8" data-representative-value="8" name="onf_q_pru_gi_eoi_osat_scale11" value="8">
                          <div aria-hidden="true" class="cellOption_indicatorContainer">
                            <div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
                              <div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">8</span>
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                      <div class="cell_cell selectionBar_selectionUnit layout_answer">
                        <div class="cellOption_cellOptionContainer" data-has-answer="true" data-should-display-as-selected="true"><input type="radio" id="onf_q_pru_gi_eoi_osat_scale11_9" aria-required="true"
                            aria-describedby="0 0_onf_q_pru_gi_eoi_osat_scale11___vvmVeB" aria-label="9 Extremely Satisfied" class="cellOption_input" data-mds-value="9" data-representative-value="9" name="onf_q_pru_gi_eoi_osat_scale11" value="9">
                          <div aria-hidden="true" class="cellOption_indicatorContainer">
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                              <div class="indicatorCircle_circle indicatorCircle_circle_isSelected"></div><span class="indicatorCircle_label indicatorCircle_label_isSelected">9</span>
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                            aria-describedby="0 0_onf_q_pru_gi_eoi_osat_scale11___vvmVeB" aria-label="10 Extremely Satisfied" class="cellOption_input" data-mds-value="10" data-representative-value="10" name="onf_q_pru_gi_eoi_osat_scale11" value="10">
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                            <div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
                              <div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">10</span>
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      </fieldset>
      <div class="htmlBlock"></div>
      <div class="questionBlock textareaQuestion">
        <fieldset>
          <div class="question_questionTitle" id="2"><span class="questionCaption">Please share any comments or reasons for your rating.</span></div>
          <div class="layout_answers">
            <div class="textarea_textareaContainer layout_answer">
              <div class="textarea_textareaContainerOverflowHidden"><textarea class="textarea_textarea" name="spl_q_pru_gi_eoi_osat_cmt_txt" id="spl_q_pru_gi_eoi_osat_cmt_txt" aria-labelledby="2"
                  aria-label="Comment box Please share any comments or reasons for your rating."></textarea></div>
            </div>
          </div>
        </fieldset>
      </div>
    </div>
    <nav class="layout_layoutContainer layout_layoutContainer_fadeIn">
      <div class="navigationButtons_navigationButtonsContainer navigationButtons_navigationButtonsContainer_hasOneButton">
        <div class="navigationButtons_pageButtonContainer"><button type="submit" class="beginButton button_button button_button_isPrimary _moveForwardButton_" id="buttonBegin" value="Begin Survey" name="forward_main-pager"><span
              class="button_buttonCaption">Begin Survey</span><i aria-hidden="true" class="medallicons_medallicons button_buttonArrowIcon"></i></button></div>
      </div>
    </nav>
    <footer class="layout_layoutContainer layout_layoutContainer_fadeIn">
      <div class="layout_footer"><span><span class="medallicons_medalliconLabel">medallia</span><i aria-hidden="true" class="medallicons_medallicons layout_medalliaLogo"></i></span>
        <div class="layout_legalLinks"><span class="copyright"><!-- react-text: 147 -->Copyright ©
            <!-- /react-text --><!-- react-text: 148 -->2023<!-- /react-text --></span><a target="_blank" rel="noopener noreferrer" href="http://surveysupport.medallia.com" data-test-name="link-support">Survey Support</a><a href="http://www.medallia.com/contact" target="_blank" rel="noopener noreferrer external" data-test-name="link-contact">Other Contact Info</a><a href="http://www.medallia.com/privacy" target="_blank" rel="noopener noreferrer external" data-test-name="link-privacy-policy">Privacy Policy</a><!-- react-empty: 152 -->
        </div>
      </div>
    </footer>
  </div>
</form>

Text Content

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RequiredHow satisfied are you with the service provided during your request for
coverage?
Not At All Satisfied
Extremely Satisfied

0

1

2

3

4

5

6

7

8

9

10

Please share any comments or reasons for your rating.

Begin Survey
medallia
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