survey3.medallia.com
Open in
urlscan Pro
147.75.243.92
Public Scan
URL:
https://survey3.medallia.com/?enrxsxn7kwv5kmswvvb9
Submission: On July 31 via manual from US — Scanned from DE
Submission: On July 31 via manual from US — Scanned from DE
Form analysis
1 forms found in the DOMName: surveyform — POST /?enrxsxn7kwv5kmswvvb9
<form name="surveyform" action="/?enrxsxn7kwv5kmswvvb9" 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/4b7753c549f60393c6fd7daea7be033f68845e39" alt="Page_logo">
</div>
<div class="layout_mainHeaderRight"><span id="languageSelector" class="">
<div>
<div class="layout_notMobileScreenOnly">
<div class="dropdown_dropdownLabel dropdown_dropdownLabel_isInactive">Choose Language:</div>
<div class="dropdown_dropdownContainer ">
<div class="dropdown_dropdownSelector dropdown_dropdownSelector_isInactive" role="button" tabindex="0" aria-haspopup="true" aria-expanded="false" title="" aria-label="Choose Language:">
<div class="dropdown_dropdownTitle">English</div><i aria-hidden="true" class="medallicons_medallicons dropdown_dropdownIcon"></i>
</div>
<div role="application">
<ul role="menu" class="dropdown_dropdownList">
<li role="menuitem" tabindex="-1" class="dropdown_dropdownListItem" data-test-name="option-english">
<!-- react-text: 27 -->English<!-- /react-text --><i aria-hidden="true" class="medallicons_medallicons dropdown_dropdownIcon"></i></li>
<li role="menuitem" tabindex="-1" class="dropdown_dropdownListItem" data-test-name="option-spanish"><!-- react-text: 30 -->Spanish<!-- /react-text --></li>
</ul>
</div>
</div>
</div>
<div class="layout_mobileScreenOnly">
<div class="dropdown_dropdownLabel dropdown_dropdownLabel_isInactive">Choose Language:</div>
<div class="dropdown_dropdownContainer ">
<div class="dropdown_dropdownSelector dropdown_dropdownSelector_isInactive" title="" aria-haspopup="true" aria-expanded="false" role="button" tabindex="0" aria-label="Choose Language:">
<div class="dropdown_dropdownTitle">English</div><i aria-hidden="true" class="medallicons_medallicons dropdown_dropdownIcon"></i>
</div>
</div>
</div>
</div><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="14"><input type="hidden" name="currentPage"
value="0"><input type="hidden" name="defPgrAction" value="next"><!-- react-empty: 44 --></div>
<div role="main" id="content" class="layout_layoutContainer layout_layoutContainer_fadeInUp">
<div class="longform_longformContainer questionBlock singleSelectQuestion">
<fieldset>
<legend class="question_questionTitle"><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">Our records show that you visited the Banner Gateway Occupational Health Clinic on March 26, 2018. <br><br>Is this correct?</span></legend>
<div class="longform_groupContainer">
<div class="layout_answers longform_group"><!-- react-text: 55 --><!-- /react-text -->
<ul class="group_group">
<li class="group_optionContainer">
<div class="layout_answer" data-test-name="option-yes">
<div id="JAWS_CLICK_TARGET" class="table_table option_optionContainer table_table_hasFixedLayout">
<div class="row_row">
<div class="cell_cell option_indicatorContainer"><input type="radio" id="onf_q_feedback_bohns_our_records_show_that_you_were_0" aria-label="Yes" class="option_input" data-mds-value="0"
name="onf_q_feedback_bohns_our_records_show_that_you_were" value="0"><span class="indicatorRadio_indicatorRadioContainer option_indicator indicatorRadio"></span></div>
<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">Yes</span></div>
</div>
</div>
</div>
</li>
<li class="group_optionContainer">
<div class="layout_answer" data-test-name="option-no">
<div id="JAWS_CLICK_TARGET" class="table_table option_optionContainer table_table_hasFixedLayout">
<div class="row_row">
<div class="cell_cell option_indicatorContainer"><input type="radio" id="onf_q_feedback_bohns_our_records_show_that_you_were_1" aria-label="No" class="option_input" data-mds-value="1"
name="onf_q_feedback_bohns_our_records_show_that_you_were" value="1"><span class="indicatorRadio_indicatorRadioContainer option_indicator indicatorRadio"></span></div>
<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">No</span></div>
</div>
</div>
</div>
</li>
</ul>
</div>
</div>
</fieldset>
</div>
<div class="htmlBlock"></div>
</div>
<nav class="layout_layoutContainer layout_layoutContainer_fadeIn">
<div class="navigationButtons_navigationButtonsContainer navigationButtons_navigationButtonsContainer_hasOneButton">
<div class="navigationButtons_pageButtonContainer"><button type="submit" class="nextButton button_button button_button_isPrimary _moveForwardButton_" id="buttonNext" value="Next" name="forward_main-pager"><span
class="button_buttonCaption">Next</span><i aria-hidden="true" class="medallicons_medallicons button_buttonArrowIcon"></i></button></div>
</div>
</nav>
<footer class="layout_layoutContainer layout_layoutContainer_fadeIn">
<div id="customfooter" class="customFooter">
<div>
<div class="layout_footer"><i class="medallicons_medallicons layout_medalliaLogo"></i>
<div class="layout_legalLinks"><a href="http://surveysupport.medallia.com/s/" target="_blank" rel="external">Survey Support</a>
<a href="https://www.bannerhealth.com/about/legal-notices/privacy" target="_blank" rel="external">Privacy Policy</a> <a href="http://survey.medallia.com/static/cookie-policy/index.html" target="_blank">Cookie Policy</a></div>
</div>
</div><!-- react-empty: 85 -->
</div>
</footer>
</div>
</form>
Text Content
Skip to Content Choose Language: English * English * Spanish Choose Language: English RequiredOur records show that you visited the Banner Gateway Occupational Health Clinic on March 26, 2018. Is this correct? * Yes * No Next Survey Support Privacy Policy Cookie Policy