apply-individual-family.kaiserpermanente.org Open in urlscan Pro
2a02:26f0:6c00::210:bb32  Public Scan

Form analysis
2 forms found in the DOM

<form _ngcontent-nvf-c93="" novalidate="" kp-validation="" class="ng-untouched ng-pristine ng-invalid">
  <div _ngcontent-nvf-c93="">
    <div _ngcontent-nvf-c93="" class="form-block">
      <h2 _ngcontent-nvf-c93="" class="title -inky-blue -locked">Primary Applicant Information</h2>
      <div _ngcontent-nvf-c93="" class="form-row">
        <div _ngcontent-nvf-c93="" class="form-group column-4"><label _ngcontent-nvf-c93="" for="lname">LAST NAME</label>
          <div _ngcontent-nvf-c93="" class="form-textbox"><input _ngcontent-nvf-c93="" id="lname" name="lname" ngmodel="" required="" class="form-control ng-untouched ng-pristine ng-invalid"><!----></div>
        </div>
        <div _ngcontent-nvf-c93="" class="form-group column-4">
          <div _ngcontent-nvf-c93="" class="custom_datepicker-single"><label _ngcontent-nvf-c93="" for="dobVerifyDate">DATE OF BIRTH</label>
            <div _ngcontent-nvf-c93="" class="form-textbox ng-dp"><input _ngcontent-nvf-c93="" id="dobVerifyDate" name="dobVerifyDate" ngbdatepicker="" required="" class="ng-untouched ng-pristine ng-invalid"><!----><button _ngcontent-nvf-c93=""
                tabindex="0" aria-label="Date Picker" id="button-ngdtp" type="button" class="ng-dp-open-btn btn btn-outline-secondarykp-blue icon-calendar-small"></button></div>
            <p _ngcontent-nvf-c93=""><!----><!----></p><!---->
          </div>
        </div>
      </div>
    </div>
  </div>
  <div _ngcontent-nvf-c93="" class="form-btn-row">
    <div _ngcontent-nvf-c93="" class="form-btn-group"><button _ngcontent-nvf-c93="" type="submit" data-analytics-type="button" class="button" data-analytics-click="Review your application-Next"> Next</button></div>
  </div>
</form>

POST

<form id="fileUploadForm" enctype="multipart/form-data" method="post" target="fileUploadIframe"><input type="file" id="fileSelector" name="file" style="display: none;"><input name="filename" type="hidden"></form>

Text Content

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PRIMARY APPLICANT INFORMATION

LAST NAME

DATE OF BIRTH




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