us.fullscript.com Open in urlscan Pro
2606:4700::6812:c7e  Public Scan

Form analysis
1 forms found in the DOM

Name: login_form — POST /user/spree_user/sign_in

<form class="form-generic form-generic--spacious patient-login patient-login--unknown-mode" name="login_form" id="patient-login" novalidate="novalidate" action="/user/spree_user/sign_in" accept-charset="UTF-8" method="post" __bizdiag="790899378"
  __biza="WJ__"><input type="hidden" name="authenticity_token" value="IQfTm/uZhYwNfBE0hLMR4E6b3NzhHM7XWUnrW2tkO10+/Z1yMDHA3fEe18MKB92kyrf6+SCK53FVBwx6oM2D9Q==">
  <input value="99770" disabled="disabled" type="hidden" name="spree_user[store_id]" id="spree_user_store_id">
  <input value="hollybowen" type="hidden" name="spree_user[store_slug]" id="spree_user_store_slug">
  <input value="clinic_landing" type="hidden" name="spree_user[source]" id="spree_user_source">
  <input type="hidden" name="spree_user[source_record]" id="spree_user_source_record">
  <div class="patient-login__initial-mode-login">
    <div id="form-error-wrapper" class="form-error-wrapper"></div>
    <div class="input-row input-row--block input-row--stacked email-wrapper">
      <label for="spree_user_email">Email *</label>
      <input value="iwanowe@northwood.edu" class="form-control" data-email="true" autofocus="autofocus" type="email" name="spree_user[email]" id="spree_user_email">
    </div>
    <div class="input-row input-row--block input-row--stacked patient-login__hide-unknown-mode pass-wrapper">
      <label data-pass-label="" for="spree_user_password"> Password * </label>
      <input data-password="" class="form-control" data-pass="true" autocomplete="off" type="password" name="spree_user[password]" id="spree_user_password">
      <a href="/password" class="below-input patient-login__hide-unknown-mode patient-login__hide-signup-mode">
      Forgot your password?
    </a>
    </div>
    <div class="input-row input-row--block input-row--stacked">
      <label class="below-input patient-login__hide-unknown-mode patient-login__hide-signup-mode">
        <input name="spree_user[remember_me]" type="hidden" value="0"><input class="inline-input" type="checkbox" value="1" name="spree_user[remember_me]" id="spree_user_remember_me"> Keep me signed in </label>
    </div>
    <div class="input-row input-row--block input-row--stacked patient-login__hide-unknown-mode patient-login__show-name-mode">
      <label for="spree_user_patients_attributes_0_first_name">First Name *</label>
      <input class="form-control" data-first-name="true" disabled="disabled" type="text" name="spree_user[patients][first_name]" id="spree_user_patients_first_name">
    </div>
    <div class="input-row input-row--block input-row--stacked patient-login__hide-unknown-mode patient-login__show-name-mode">
      <label for="spree_user_patients_attributes_0_last_name">Last Name *</label>
      <input class="form-control" data-last-name="true" disabled="disabled" type="text" name="spree_user[patients][last_name]" id="spree_user_patients_last_name">
    </div>
    <div class="submit-wrapper">
      <div class="mobile-shown pt25 patient-login__hide-always">
        <span> Already have an account? <a href="/login/hollybowen">Login here</a>
        </span>
      </div>
      <button id="submit-button" type="submit" class="hw-btn hw-btn-primary mt15">Submit</button>
      <script src="https://www.google.com/recaptcha/api.js?render=6LfubsYZAAAAACROKpNY8oqTHCPGVIz7dvbhXA_D"></script>
      <script>
        document.getElementById("submit-button").onclick = function() {
          grecaptcha.ready(function() {
            var signupForm = document.getElementById("patient-login");
            var isSignupMode = RegExp('(\\s|^)' + "patient-login--signup-mode" + '(\\s|$)').test(signupForm.className);
            if (isSignupMode) {
              try {
                grecaptcha.execute("6LfubsYZAAAAACROKpNY8oqTHCPGVIz7dvbhXA_D", {
                  action: "create_patient_new_signup"
                }).then(function(token) {
                  var recaptchaScoreInput = document.getElementById('captcha-token');
                  recaptchaScoreInput.value = token;
                  signupForm.appendChild(recaptchaScoreInput);
                  var event = new Event('change');
                  recaptchaScoreInput.dispatchEvent(event);
                })
              } catch (err) {
                var recaptchaScoreInput = document.getElementById('captcha-token');
                recaptchaScoreInput.value = "CAPTCHA_JS_ERROR";
                signupForm.appendChild(recaptchaScoreInput);
                var event = new Event('change');
                recaptchaScoreInput.dispatchEvent(event);
              }
            }
          });
        }
      </script>
      <div class="protected-by-captcha mute"> This page is protected by reCAPTCHA, and subject to the Google <a target="_blank" href="https://policies.google.com/privacy">Privacy Policy</a> and
        <a target="_blank" href="https://policies.google.com/terms">Terms of Service</a>
      </div>
      <div id="captcha-badge"></div>
      <input id="captcha-token" class="hidden" name="captcha_token">
    </div>
  </div>
</form>

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