www.apolloclinic.com
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urlscan Pro
192.145.233.103
Public Scan
Submitted URL: http://apolloclinic.com/
Effective URL: https://www.apolloclinic.com/
Submission: On May 20 via api from US — Scanned from DE
Effective URL: https://www.apolloclinic.com/
Submission: On May 20 via api from US — Scanned from DE
Form analysis
11 forms found in the DOMPOST https://www.apolloclinic.com/search
<form method="post" action="https://www.apolloclinic.com/search" novalidate="">
<input class="search_text" id="search_text" name="search_text" type="text" placeholder="Site Search"> <input type="hidden" name="searchfor" value="all">
<button type="submit" class="search_submit">Search</button>
</form>
Name: form1 — POST download.php
<form action="download.php" method="post" name="form1" id="form1" target="_blank">
<!--<input name="schema" type="hidden" value="ahllclinics" />
<input name="error_url" type="hidden" value="http://www.google.com" />-->
<div class="form_field full_width">
<input type="text" name="visit_id" id="visit_id" placeholder="User Name" class="inpt" style="border: 1px solid #ccc;"> <span class="user_icon"></span>
</div>
<div class="form_field full_width">
<input type="password" name="passcode" id="passcode" placeholder="Password" autocomplete="off" class="inpt" style="border: 1px solid #ccc;"> <span class="password_icon"></span>
</div>
<span id="spanDownload">
<p>(Please refer to bill for user name & password)</p>
</span>
</form>
Name: form2 — POST download.php
<form action="download.php" method="post" name="form2" id="form2" target="_blank">
<!--<input name="schema" type="hidden" value="ahllclinics" />
<input name="error_url" type="hidden" value="http://www.google.com" />-->
<div class="form_field full_width">
<input type="text" name="visit_id" id="visit_id2" placeholder="User Name" class="inpt" style="border: 1px solid #ccc;"> <span class="user_icon"></span>
</div>
<div class="form_field full_width">
<input type="password" name="passcode" id="passcode2" placeholder="Password" autocomplete="off" class="inpt" style="border: 1px solid #ccc;"> <span class="password_icon"></span>
</div>
<span id="spanDownload2">
<p>(Please refer to bill for user name & password)</p>
</span>
</form>
post
<form onsubmit="return submitSubscribe()" action="post">
<input type="text" id="newsletter_email" name="newsletter_email" placeholder="Email Address" class="sb-search-input"> <span class="sb-icon-search" id="subscribe_load" style="display: none">Loading...</span>
<button class="sb-icon-search" type="submit" id="subscribe_btn">Subscribe</button>
</form>
Name: requestcall — POST https://www.apolloclinic.com/form/requestCall
<form onsubmit="return false" novalidate="novalidate" action="https://www.apolloclinic.com/form/requestCall" method="post" enctype="multipart/form-data" name="requestcall" id="trequestcall" role="form">
<div class="request_from show">
<div class="modal-body">
<div class="row">
<div class="col-lg-12">
<div class="form-group">
<label for="fullname">Full name <strong style="color: #F00">*</strong></label>
<input type="text" class="form-control" id="rfullname" name="rfullname" placeholder="Full name" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-lg-12">
<div class="form-group">
<label for="mobile">Mobile <strong style="color: #F00">*</strong></label>
<input type="text" class="form-control" id="rmobile" name="rmobile" placeholder="Mobile" required="">
</div>
</div>
</div>
</div>
<div class="modal-footer trequestcallload">
<button type="button" class="btn btn-default" data-dismiss="modal">Cancel</button>
<button type="submit" class="btn btn-primary">Submit</button>
</div>
<div class="modal-footer trequestcallloading" style="display: none">Submitting the form Please wait...</div>
</div>
<div class="sucess_msg hide"></div>
<div class="error_msg hide"></div>
</form>
<form class="form4" id="form4" style="text-align:center;">
<input type="phone" id="phone" name="user_phone" placeholder="Mobile Number" class="user_phone inpt" style="margin:5px;">
<br>
<button type="submit" class="btn btn-primary" style="float:none;margin:5px;">Generate OTP</button>
</form>
<form class="form2" id="form2" style="display:none;text-align:center;">
<input type="number" id="otp" name="user_otp" placeholder="Enter OTP" style="text-align:center;margin:5px;">
<input type="hidden" name="user_phone_otp" class="user_phone_otp">
<button type="submit" class="btn btn-primary" style="margin:5px;float:none;">Verify OTP</button>
</form>
<form id="quick_appointment_widget" class="quick_appointment_widget quick_appointment_widget_form">
<div class="appointment_response"></div>
<div class="row">
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group">
<input type="text" name="fname" id="" class="form-control" placeholder="First Name">
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group">
<input type="text" name="lname" id="" class="form-control" placeholder="Last Name">
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group">
<input type="email" name="email" id="" class="form-control" placeholder="Email">
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group">
<input type="tel" name="phone" id="" class="form-control" placeholder="Phone No.">
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group">
<input type="text" name="dob" id="dp1653058466748" class="form-control dob_field hasDatepicker" placeholder="DOB">
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group">
<select name="gender" class="form-control" id="field_gender">
<option value="">Select Gender</option>
<option value="1">Male</option>
<option value="2">Female</option>
</select>
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group">
<select name="cityId" class="form-control field_city" data-form-class=".quick_appointment_widget_form">
<option value="0">Select City</option>
<option value="3015" data-city="Bangalore">Bangalore</option>
<option value="4413" data-city="Chandigarh">Chandigarh</option>
<option value="1" data-city="Chennai">Chennai</option>
<option value="4791" data-city="Coimbatore">Coimbatore</option>
<option value="5867" data-city="Dehradun">Dehradun</option>
<option value="2741" data-city="Delhi">Delhi</option>
<option value="2995" data-city="Dhanbad">Dhanbad</option>
<option value="5899" data-city="Ghaziabad">Ghaziabad</option>
<option value="5907" data-city="Gorakhpur">Gorakhpur</option>
<option value="545" data-city="Guntur">Guntur</option>
<option value="2899" data-city="Gurugram">Gurugram</option>
<option value="2207" data-city="Guwahati">Guwahati</option>
<option value="12" data-city="Hyderabad">Hyderabad</option>
<option value="3371" data-city="Kannur">Kannur</option>
<option value="13" data-city="Kolkata">Kolkata</option>
<option value="5955" data-city="Lucknow">Lucknow</option>
<option value="3989" data-city="Mumbai">Mumbai</option>
<option value="3175" data-city="Mysore">Mysore</option>
<option value="3991" data-city="Nagpur">Nagpur</option>
<option value="3999" data-city="Nasik">Nasik</option>
<option value="4007" data-city="Pune">Pune</option>
<option value="6388" data-city="Raipur">Raipur</option>
<option value="1549" data-city="Rangareddy">Rangareddy</option>
<option value="2867" data-city="Surat">Surat</option>
<option value="4037" data-city="Thane">Thane</option>
<option value="1827" data-city="Tirupati">Tirupati</option>
<option value="3571" data-city="Trivandrum">Trivandrum</option>
<option value="2873" data-city="Vadodara">Vadodara</option>
<option value="1983" data-city="Visakhapatnam">Visakhapatnam</option>
<option value="3015" data-city="Bangalore">Bangalore</option>
<option value="4413" data-city="Chandigarh">Chandigarh</option>
<option value="1" data-city="Chennai">Chennai</option>
<option value="4791" data-city="Coimbatore">Coimbatore</option>
<option value="5867" data-city="Dehradun">Dehradun</option>
<option value="2741" data-city="Delhi">Delhi</option>
<option value="2995" data-city="Dhanbad">Dhanbad</option>
<option value="5899" data-city="Ghaziabad">Ghaziabad</option>
<option value="5907" data-city="Gorakhpur">Gorakhpur</option>
<option value="545" data-city="Guntur">Guntur</option>
<option value="2899" data-city="Gurugram">Gurugram</option>
<option value="2207" data-city="Guwahati">Guwahati</option>
<option value="12" data-city="Hyderabad">Hyderabad</option>
<option value="3371" data-city="Kannur">Kannur</option>
<option value="13" data-city="Kolkata">Kolkata</option>
<option value="5955" data-city="Lucknow">Lucknow</option>
<option value="3989" data-city="Mumbai">Mumbai</option>
<option value="3175" data-city="Mysore">Mysore</option>
<option value="3991" data-city="Nagpur">Nagpur</option>
<option value="3999" data-city="Nasik">Nasik</option>
<option value="4007" data-city="Pune">Pune</option>
<option value="6388" data-city="Raipur">Raipur</option>
<option value="1549" data-city="Rangareddy">Rangareddy</option>
<option value="2867" data-city="Surat">Surat</option>
<option value="4037" data-city="Thane">Thane</option>
<option value="1827" data-city="Tirupati">Tirupati</option>
<option value="3571" data-city="Trivandrum">Trivandrum</option>
<option value="2873" data-city="Vadodara">Vadodara</option>
<option value="1983" data-city="Visakhapatnam">Visakhapatnam</option>
<option value="3015" data-city="Bangalore">Bangalore</option>
<option value="4413" data-city="Chandigarh">Chandigarh</option>
<option value="1" data-city="Chennai">Chennai</option>
<option value="4791" data-city="Coimbatore">Coimbatore</option>
<option value="5867" data-city="Dehradun">Dehradun</option>
<option value="2741" data-city="Delhi">Delhi</option>
<option value="2995" data-city="Dhanbad">Dhanbad</option>
<option value="5899" data-city="Ghaziabad">Ghaziabad</option>
<option value="5907" data-city="Gorakhpur">Gorakhpur</option>
<option value="545" data-city="Guntur">Guntur</option>
<option value="2899" data-city="Gurugram">Gurugram</option>
<option value="2207" data-city="Guwahati">Guwahati</option>
<option value="12" data-city="Hyderabad">Hyderabad</option>
<option value="3371" data-city="Kannur">Kannur</option>
<option value="13" data-city="Kolkata">Kolkata</option>
<option value="5955" data-city="Lucknow">Lucknow</option>
<option value="3989" data-city="Mumbai">Mumbai</option>
<option value="3175" data-city="Mysore">Mysore</option>
<option value="3991" data-city="Nagpur">Nagpur</option>
<option value="3999" data-city="Nasik">Nasik</option>
<option value="4007" data-city="Pune">Pune</option>
<option value="6388" data-city="Raipur">Raipur</option>
<option value="1549" data-city="Rangareddy">Rangareddy</option>
<option value="2867" data-city="Surat">Surat</option>
<option value="4037" data-city="Thane">Thane</option>
<option value="1827" data-city="Tirupati">Tirupati</option>
<option value="3571" data-city="Trivandrum">Trivandrum</option>
<option value="2873" data-city="Vadodara">Vadodara</option>
<option value="1983" data-city="Visakhapatnam">Visakhapatnam</option>
<option value="3015" data-city="Bangalore">Bangalore</option>
<option value="4413" data-city="Chandigarh">Chandigarh</option>
<option value="1" data-city="Chennai">Chennai</option>
<option value="4791" data-city="Coimbatore">Coimbatore</option>
<option value="5867" data-city="Dehradun">Dehradun</option>
<option value="2741" data-city="Delhi">Delhi</option>
<option value="2995" data-city="Dhanbad">Dhanbad</option>
<option value="5899" data-city="Ghaziabad">Ghaziabad</option>
<option value="5907" data-city="Gorakhpur">Gorakhpur</option>
<option value="545" data-city="Guntur">Guntur</option>
<option value="2899" data-city="Gurugram">Gurugram</option>
<option value="2207" data-city="Guwahati">Guwahati</option>
<option value="12" data-city="Hyderabad">Hyderabad</option>
<option value="3371" data-city="Kannur">Kannur</option>
<option value="13" data-city="Kolkata">Kolkata</option>
<option value="5955" data-city="Lucknow">Lucknow</option>
<option value="3989" data-city="Mumbai">Mumbai</option>
<option value="3175" data-city="Mysore">Mysore</option>
<option value="3991" data-city="Nagpur">Nagpur</option>
<option value="3999" data-city="Nasik">Nasik</option>
<option value="4007" data-city="Pune">Pune</option>
<option value="6388" data-city="Raipur">Raipur</option>
<option value="1549" data-city="Rangareddy">Rangareddy</option>
<option value="2867" data-city="Surat">Surat</option>
<option value="4037" data-city="Thane">Thane</option>
<option value="1827" data-city="Tirupati">Tirupati</option>
<option value="3571" data-city="Trivandrum">Trivandrum</option>
<option value="2873" data-city="Vadodara">Vadodara</option>
<option value="1983" data-city="Visakhapatnam">Visakhapatnam</option>
</select>
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group">
<span id="field_clinics-loader" class="field-loader field_clinics-loader"><i class="fa fa-spinner fa-spin"></i></span>
<select name="hospitalId" class="form-control field_clinics" data-form-class=".quick_appointment_widget_form">
<option value="0">Select Clinic</option>
</select>
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group">
<span id="field_speciality-loader" class="field-loader field_speciality-loader"><i class="fa fa-spinner fa-spin"></i></span>
<select name="specialityId" class="form-control field_speciality" data-form-class=".quick_appointment_widget_form">
<option value="0">Select Speciality</option>
</select>
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group">
<span id="field_doctor-loader" class="field-loader field_doctor-loader"><i class="fa fa-spinner fa-spin"></i></span>
<select name="doctorId" class="form-control field_doctor" data-form-class=".quick_appointment_widget_form">
<option value="0">Select Doctor</option>
</select>
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6">
<div class="form-group dates-wrap">
<span class="field-loader appointmentpicker-loader"><i class="fa fa-spinner fa-spin"></i></span>
<input type="text" name="date" class="form-control appointmentpicker fa fa-arrow-right" placeholder="Select Date" readonly="readonly" data-form-class=".quick_appointment_widget_form">
<span class="dates-preloader" style="display: none;">Loading Available Dates...</span>
</div>
</div>
<div class="col-md-6 col-sm-6 col-xs-6 slots-container">
<div class="form-group">
<span class="field-loader field_slot-loader"><i class="fa fa-spinner fa-spin"></i></span>
<select name="slotTime" class="form-control field_slot" data-form-class=".quick_appointment_widget_form">
<option value="0">Select Slot</option>
</select>
<span class="slots-preloader" style="display: none;">Loading Available Slots...</span>
<input type="hidden" name="slotId" class="field_slot_id" value="" data-form-class=".quick_appointment_widget_form">
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<select name="mode" class="form-control" id="field_appointment_mode">
<option value="">Select Mode</option>
<option value="Physical Consult">Physical Consult</option>
<option value="Tele Consult">Tele Consult</option>
</select>
</div>
</div>
<div class="col-md-12 consent-checkbox">
<input type="checkbox" name="concern" value="true" id="concern"><label for="true"> I Agree "<a type="button" data-toggle="modal" class="btn-modal-consent" data-target="#concernModal">Patient Information Consent</a>"</label>
</div>
<div class="col-md-12 col-sm-12 col-xs-12">
<input type="hidden" name="cityName" class="cityName" id="cityName" value="">
<input type="hidden" name="specialityName" class="specialityName" id="" value="">
<input type="hidden" name="doctorName" class="doctorName" id="" value="">
<input type="hidden" name="hospitalName" class="hospitalName" id="" value="">
<input type="hidden" name="appointment_type" class="appointment_type appointment_type_input" value="">
<input type="hidden" name="action" value="ConfirmConsultationAppointment">
<button class="btn btn-primary btn-confirm-appointment" data-form-class=".quick_appointment_widget_form">Submit</button>
<button type="button" class="btn btn-default" data-dismiss="modal">Cancel</button>
</div>
</div>
</form>
Name: bookappnew — POST #
<form onsubmit="return false" novalidate="novalidate" action="#" method="post" enctype="multipart/form-data" name="bookappnew" id="bookapp" role="form" style="display:none;">
<div class="app_form show">
<div class="modal-body" style="padding: 15px 15px 0px 15px;">
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<input type="text" class="form-control" id="fullname" name="fullname" placeholder="Full Name *" required="">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<input type="text" class="form-control" name="phonenumber" id="phonenumber" placeholder="Mobile *" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<input type="email" class="form-control" name="email" id="email" placeholder="Email Address *" required="">
</div>
</div>
<div class="col-lg-6">
<div class="form-group countryselecting">
<select id="hcountry" class="select2 appAddresscountry hspeccountry" name="country" onchange="countryChange(this.value)" style="width: 100%" required="">
<option value="">Select Country</option>
<option value="India">India</option>
<option value="Qatar">Qatar</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-6">
<div class="form-group selecting">
<select id="address" class="select2 appAddress appAddressdyn" onchange="areaChange(this.value)" name="address" style="width: 100%" required="">
<option value="">Please Select City</option>
</select>
</div>
</div>
<div class="col-lg-6">
<div class="form-group selecting">
<select id="harea" class="select2 appAddress harea" name="area" onchange="specialityChange(this.value)" style="width: 100%" required="">
<option value="">Select Clinic Location</option>
</select>
</div>
</div>
</div>
<div class="row hdselectforser">
<div class="col-lg-12">
<div class="form-group selecting">
<select id="hspecmainserv" class="select2 clshspecmainserv" name="homeservice" style="width: 100%" required="">
<option value="">Select Service</option>
<option value="Consultations">Consultations</option>
<option value="Diagnostics">Diagnostics</option>
<option value="Health_checks">Health checks</option>
<option value="Dental">Dental</option>
<option value="Physiotherapy">Physiotherapy</option>
<!-- <option value="Specialty_Clinics">Specialty Clinics</option>
<option value="Treatment_Room">Treatment Room</option> -->
<option value="Vaccinations">Vaccinations</option>
<!-- <option value="Health_Home">Health @ Home</option> -->
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<input type="text" class="form-control alldatepicker hasDatepicker" id="appoinment2" name="appoinment" placeholder="Appointment" required="" onchange="dateChangenew(this.value)">
</div>
</div>
<div class="col-lg-6">
<div class="form-group selecting">
<select id="clinictime" class="select2 appAddress clinictime" name="clinicTime" style="width: 100%" required="">
<option value="">Select Time Slot</option>
<option value="Morning (8 AM to 12 PM)">Morning (8 AM to 12 PM)</option>
<option value="Afternoon (1 PM to 4 PM)">Afternoon (1 PM to 4 PM)</option>
<option value="Evening (5 PM to 9 PM)">Evening (5 PM to 9 PM)</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-12">
<div class="form-group">
<textarea type="text" class="form-control" id="message" name="message" placeholder="Message" required=""></textarea>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-12">
<div class="form-group">
<span style="color: #ff0000;">Note:</span> The confirmation of appointment will be confirmed by our backend team and it is subject to availability of doctors or time slot.
</div>
</div>
</div>
</div>
<div class="modal-footer appointload">
<button type="button" class="btn btn-default" data-dismiss="modal">Cancel</button>
<button type="submit" class="btn btn-primary newsbtnew">Submit</button>
</div>
<div class="modal-footer appointloading" style="display: none"> Submitting the form Please wait...</div>
</div>
<div class="sucess_msg_bp hide"></div>
<div class="error_msg_bp hide"></div>
</form>
Name: bookapp — POST #
<form onsubmit="return false" novalidate="novalidate" action="#" method="post" enctype="multipart/form-data" name="bookapp" id="bookapp3" role="form">
<div class="app_form show">
<div class="modal-footer appointloading" style="display: none"> Submitting the form Please wait...</div>
</div>
<div class="sucess_msg_bp hide"></div>
<div class="error_msg_bp hide"></div>
</form>
Name: samplecollection — POST #
<form onsubmit="return false" novalidate="novalidate" action="#" method="post" enctype="multipart/form-data" name="samplecollection" id="samplecollection" role="form">
<div class="sample_collection show">
<div class="modal-body">
<div class="row">
<div class="col-lg-12">
<div class="form-group">
<label for="fullname">Full Name <strong style="color: #F00">*</strong></label>
<input type="text" class="form-control" id="cfullname" name="cfullname" placeholder="Full name" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-lg-12">
<div class="form-group">
<label for="cemail">Email <strong style="color: #F00">*</strong></label>
<input type="email" class="form-control" id="cemail" name="cemail" placeholder="Email Address" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-lg-12">
<div class="form-group">
<label for="cmobile">Mobile <strong style="color: #F00">*</strong></label>
<input type="text" class="form-control" id="cmobile" name="cmobile" placeholder="Mobile" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-lg-12">
<div class="form-group">
<label for="cmobile">Enter Test Name <strong style="color: #F00">*</strong></label> <input type="text" class="form-control" id="ctests" name="ctests" placeholder="Tests" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-lg-12">
<div class="form-group">
<label for="address">Address <strong style="color: #F00">*</strong></label>
<textarea class="form-control" id="caddress" name="caddress" placeholder="Address" required=""></textarea>
</div>
</div>
</div>
</div>
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Contact information: Name, Address, Contact details, Email ID, Phone Number; b. Demographic information: Gender, Age, Date of Birth, Marital Status, Nationality; c. Other information that I provide to AHLL or is generated while availing services or interacting with AHLL employees, doctors, technicians, consultants, etc.; d. Health information such as my medical records and history provided by me or generated by AHLL in the course of my availing of any services from AHLL; e. Information about my insurance coverage provided by me or generated on availing any services from AHLL; f. Information regarding my physical, physiological and mental health provided by me or generated on availing any services from AHLL, etc.; g. Financial information (payment/billing information) that I provide for availing services from AHLL; and h. Any other information relating to the above which I may have shared with AHLL prior to the date of this consent form for availing any services. 2. Purpose of Collection: I understand that AHLL may use the information mentioned above to provide me with services, or use it for other purposes, some of which are below: a. Registration to receive services, maintenance of my unified health profile/records, identification, communication, information on new services and offers, taking feedback, help and complaint resolution, other customer care related activities or issues relating to the use of my services; b. Creation and maintenance of electronic health records for use by AHLL, Apollo group companies and affiliates, to provide relevant services; c. Receiving personalized announcements/offers of various Apollo group companies; d. Customising suggestions for appropriate medical products and services offered by AHLL and affiliates; e. Research for the development and improvement of our products and services including our diagnostics and treatment protocols; f. 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