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marketing.avidiahealth.com Open in urlscan Pro
207.189.124.33  Public Scan

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Submitted URL: https://marketing.avidiahealth.com/acton/ct/35052/s-012a-2305/Bct/l-0029/l-0029:1f32/ct4_0/1/lu?sid=TV2%3Aii2ahLKqY
Effective URL: https://marketing.avidiahealth.com/acton/fs/blocks/ftaf/a/35052/m/s-012a-2305/r/l-0029%3A1f32/?sid=TV2:ii2ahLKqY
Submission: On May 23 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST /acton/blocks/ftafSubmit.jsp

<form id="form" method="post" action="/acton/blocks/ftafSubmit.jsp" data-parsley-validate="" novalidate="" style="display: block;">
  <table width="600">
    <tbody>
      <tr align="left" valign="top">
        <td colspan="2">
          <h1>Forward to a Friend</h1>
        </td>
      </tr>
      <tr align="left" valign="top">
        <td>Email Address:</td>
        <td><input style="width: 300px" type="text" name="Email" data-parsley-required="" data-parsley-type="email" data-parsley-id="8203">
          <ul class="parsley-errors-list" id="parsley-id-8203"></ul>
        </td>
      </tr>
      <tr align="left" valign="top">
        <td>First Name:</td>
        <td><input style="width: 300px" type="text" name="FirstName" data-parsley-required="" data-parsley-id="5920">
          <ul class="parsley-errors-list" id="parsley-id-5920"></ul>
        </td>
      </tr>
      <tr align="left" valign="top">
        <td>Last Name:</td>
        <td><input style="width: 300px" type="text" name="LastName" data-parsley-required="" data-parsley-id="8638">
          <ul class="parsley-errors-list" id="parsley-id-8638"></ul>
        </td>
      </tr>
      <tr align="left" valign="top">
        <td>From:</td>
        <td>SCOTT BROWN</td>
      </tr>
      <tr align="left" valign="top">
        <td>Message:</td>
        <td>
          <textarea id="message" maxlength="300" name="Message" data-parsley-maxlength="300" data-parsley-id="7849">I thought you might like this!</textarea>
          <ul class="parsley-errors-list" id="parsley-id-7849"></ul>
          <div style="font-size: 0.8em; color: #A9A9A9">300 characters max</div>
        </td>
      </tr>
      <tr>
        <td colspan="2" align="middle"><input type="submit" value="Send Now"></td>
      </tr>
    </tbody>
  </table>
  <input type="hidden" name="recname" value="SCOTT BROWN">
  <input type="hidden" name="recemail" value="sbrown1@2u.com">
  <input type="hidden" name="aid" value="35052">
  <input type="hidden" name="mid" value="s-012a-2305">
  <input type="hidden" name="rid" value="l-0029:1f32">
  <input type="hidden" name="formURL" value="https://marketing.avidiahealth.com/acton/fs/blocks/ftaf/a/35052/m/s-012a-2305/r/l-0029%3A1f32/?sid=TV2:ii2ahLKqY">
</form>

Text Content

THANK YOU!


YOUR MESSAGE WILL BE SENT SHORTLY.


FORWARD TO A FRIEND

Email Address: First Name: Last Name: From:SCOTT BROWN Message: I thought you
might like this!
300 characters max