sm.dyzsfk02.com
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211.149.240.137
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URL:
https://sm.dyzsfk02.com/
Submission: On June 07 via api from US — Scanned from DE
Submission: On June 07 via api from US — Scanned from DE
Form analysis
1 forms found in the DOMName: gh_form — POST /plus/phpmail/sendmail.php
<form id="gh_form" name="gh_form" onsubmit="javascript:return check();" target="_blank" autocomplete="off" method="post" action="/plus/phpmail/sendmail.php">
<ul>
<li><span>患者姓名:</span>
<input style="width:94px; margin-right:6px;" name="name" id="name" type="text" value="您的姓名" onfocus="if (this.value == this.defaultValue) {
this.value = '';this.style.color = 'black';};" onblur="if (this.value == '') {
this.value = this.defaultValue;
this.style.color = '#666';
}"><span class="left">年龄:</span>
<input style="width:36px;" name="age" id="age" type="text" onblur="this.value = ignoreSpaces(this.value);">
</li>
<li><span class="left">手机号码:</span>
<input name="hometel" id="hometel" type="text" value="请填入您的联系方式" onfocus="if (this.value == this.defaultValue) {
this.value = '';
this.style.color = 'black';
}
;" onblur="if (this.value == '') {
this.value = this.defaultValue;
this.style.color = '#666';}">
</li>
<li><span class="left">就诊日期:</span>
<input type="date" name="date" id="date" value="" size="10" onblur="this.value = ignoreSpaces(this.value);">
</li>
<li><span class="left">病情描述:</span>
<textarea name="remarks" id="remarks"></textarea>
</li>
</ul>
<div class="blank"></div>
<div class="center">
<input type="hidden" name="url" id="urlgh" value="https://sm.dyzsfk02.com/">
<script>
var tsr = window.location.href;
var u = document.getElementById("urlgh");
u.value = tsr;
</script>
<a href="javascript:void(0);" onclick="onKST();"><input name="submit" type="button" value="提交预约"></a>
</div>
</form>
Text Content
咨询 关闭 您好,这里是德阳中康医院官方预约平台,有什么可以帮您的,请讲! * 医院介绍 * 就医指南 * 来院路线 * 诊疗项目 * 就医环境 * 医院地址 深入贯彻卫计委工作意见 网络预约免挂号费 享优先就诊权利 * 患者姓名: 年龄: * 手机号码: * 就诊日期: * 病情描述: 旌阳中康医院 医院地址:德阳市旌阳区龙泉山北路19号 咨询热线:18683753503 版权所有:旌阳中康医院 Copyright © 2023 备案号:蜀ICP备12025153号-1 * 预约挂号 * 立即通话 * 在线咨询