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URL:
https://www.healthsoul.com/health-insurance/usa/wellmark-bcbs-iowa
Submission: On November 08 via manual (November 8th 2022, 5:44:03 pm UTC) from US — Scanned from DE

Form analysis
3 forms found in the DOM

POST

<form action-xhr="/233/appointments" accept-charset="UTF-8" method="post" novalidate="" class="i-amphtml-form amp-form-dirty">
  <input type="hidden" name="authenticity_token" id="authenticity_token" value="FdnLJl761ieN1UnOgqVykZKPJwPTYXC4od66NTuDKL2K0Io0xkF4Gg0hKZWB8jabvJDbBnDlbvkHeFg+8a2lgA==">
  <div class="form-group">
    <div class="row">
      <div class="col-md-6">
        <label for="Date_">Date*</label>
        <input type="date" name="appointment[date]" id="appointment_date" value="2022-11-08" min="2022-11-08" max="2023-11-08" class="datetime-future form-control appointment_date">
      </div>
      <div class="col-md-6">
        <label for="Reason_">Reason*</label>
        <input type="text" name="appointment[reason]" id="appointment_reason" required="required" class="form-control">
      </div>
    </div>
  </div>
  <div class="form-group">
    <div class="row">
      <div class="col-md-3 mt-3-percent">
        <label for="New_Patient">New patient</label>
        <input type="radio" name="appointment[new_patient]" id="appointment_new_patient_true" value="true" checked="checked">
      </div>
      <div class="col-md-3 mt-3-percent">
        <label for="Follow_Up">Follow up</label>
        <input type="radio" name="appointment[new_patient]" id="appointment_new_patient_false" value="false">
      </div>
      <div class="col-md-6">
        <label for="Time_">Time*</label>
        <select name="appointment[time]" id="appointment_time" class="form-control">
          <option value="09:00:00">9:00am - 10.00am</option>
          <option value="10:00:00">10:00am - 11.00am</option>
          <option value="11:00:00">11:00am - 12.00pm</option>
          <option value="12:00:00">12:00pm - 01.00pm</option>
          <option value="13:00:00">01:00pm - 02.00pm</option>
        </select>
      </div>
    </div>
  </div>
  <h4> Your Information </h4>
  <div class="form-group">
    <div class="row">
      <div class="col-md-6">
        <label for="First_Name_">First name*</label>
        <input type="text" name="appointment[user][first_name]" id="appointment_user_first_name" required="required" class="form-control">
      </div>
      <div class="col-md-6">
        <label for="Last_Name_">Last name*</label>
        <input type="text" name="appointment[user][last_name]" id="appointment_user_last_name" required="required" class="form-control">
      </div>
      <div class="col-md-6">
        <label for="Date_of_Birth_">Date of birth*</label>
        <div class="select-container">
          <div class="select-container">
            <input type="date" name="appointment[user][date_of_birth]" id="appointment_user_date_of_birth" value="2022-11-08" min="1872-11-08" max="2022-11-08" class="form-control">
          </div>
        </div>
      </div>
      <div class="col-md-6">
        <label for="Email_">Email*</label>
        <input type="email" name="appointment[user][email]" id="appointment_user_email" required="required" class="form-control">
      </div>
    </div>
  </div>
  <div class="form-group">
    <div class="row">
      <div class="col-md-3">
        <select name="appointment[user][phone_country_code]" id="appointment_user_phone_country_code" class="form-control country-code-select height_100_percent">
          <option value="01">+01 (USA)</option>
          <option value="91">+91 (IND)</option>
          <option value="61">+61 (AUS)</option>
          <option value="64">+64 (NZL)</option>
          <option value="92">+92 (PAK)</option>
        </select>
      </div>
      <div class="col-md-9">
        <input type="text" name="appointment[user][phone_body]" id="appointment_user_phone_body" value="" placeholder="10 Digit Phone Number (No Hyphens)" required="required" class="form-control ten-digit-number">
        <input type="hidden" name="appointment[user][phone_number]" id="appointment_user_phone_number" value="" class="hidden_phone_number form-control">
      </div>
    </div>
  </div> Your information will be shared with the office you are requesting appointment with and stored in your user profile<br>
  <div submit-success="" class="error-msg-outer">
    <template type="amp-mustache">
      <span>{{message}}</span>
    </template>
  </div>
  <div submit-error="" class="error-msg-outer">
    <template type="amp-mustache">
      <span class="error_msg">{{message}}</span>
    </template>
  </div>
  <button name="button" type="submit" class="btn btn-primary">Submit</button>
</form>

POST

<form action-xhr="/gdpr_opt_in" accept-charset="UTF-8" method="post" novalidate="" class="i-amphtml-form">
  <div class="accept_btn">
    <input name="authenticity_token" value="M7jmXpXFN1uWA6t5E3BaWhDNQ1w69+/kqgpGhSt8a1qssadMDX6ZZhb3yyIQJx5QPtK/WZlz8aUMrKSO4VLmZw==" type="hidden">
    <button class="btn btn-primary" id="accept-gdpr"> Accept </button>
  </div>
</form>

POST

<form id="subscribe_new_user_form" class="simple_form new_user i-amphtml-form" action-xhr="/create_subscription_only_user" accept-charset="UTF-8" method="post" novalidate="">
  <input type="hidden" name="authenticity_token" id="authenticity_token" value="aSBlN+UZIFtvYOqhd4lgIG/D6dkJOF6jQZ3yGTL7ekP2KSQlfaKOZu+Uivp03iQqQdwV3Kq8QOLnOxAS+NX3fg==">
  <div class="subscribe-input"><input class="user-valid valid form-control subscribe_input_box" id="subscribe_new_user" required="required" aria-required="true" placeholder="Enter Email" type="email" value="" name="user[email]"></div>
  <button>SUBSCRIBE TO OUR NEWSLETTER</button>
</form>

Text Content

Schedule a Demo Free Digital Assessment
 * Solutions
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Wellmark BCBS, Iowa

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WELLMARK BCBS, IOWA

1331 Grand Avenue, Des Moines, IA, 50309, USA

Website

515-376-4500

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 * Overview
   


OVERVIEW OF WELLMARK BCBS, IOWA



We're Wellmark, Inc., an independent licensee of the Blue Cross Blue Shield
Association. We're also a mutual insurance company, which means we're owned by
our policy holders, not investors — and that's important. Since we're owned by
our friends and neighbors throughout Iowa and South Dakota, we know what's
important. Wellmark members demand exceptional value. We work hard every day to
deliver that by carefully managing costs, providing outstanding customer service
and empowering our members to stay healthy.




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HEALTHCARE Q&A

Do You Have Questions About Healthcare? ASK A QUESTION


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BLOG POSTS

FIVE REASONS WHY PERSONAL PROTECTIVE EQUIPMENT AT WORK SHOULDN'T BE IGNORED

AVOIDING THE SPAM BOX WITH CAREFUL HEALTHCARE EMAIL MARKETING

IS THERE A SPECIFIC IELTS PASSING SCORE FOR USA PLACEMENT?

ARE YOU AWARE OF YOUR RISK FACTORS FOR KIDNEY DISEASE? WHAT YOU NEED TO KNOW



FEATURED DOCTOR

Wismann


DR. ANDREA WISMANN

Family Medicine

Make an Appointment - (719) 523-4501

Manalo


DR. ANTONIO MANALO

Family Medicine

Make an Appointment - (719) 523-4501

Greene


DR. DANA GREENE

Family Medicine

Make an Appointment - (719) 523-4501



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×

YOU ARE REQUESTING AN APPOINTMENT WITH WELLMARK BCBS, IOWA

To request an appointment, choose to call the office directly or fill out the
request form below.

LOCATION PHONE

515-376-4500

--------------------------------------------------------------------------------

APPOINTMENT INFORMATION

Date*
Reason*
New patient
Follow up
Time* 9:00am - 10.00am 10:00am - 11.00am 11:00am - 12.00pm 12:00pm - 01.00pm
01:00pm - 02.00pm

YOUR INFORMATION

First name*
Last name*
Date of birth*

Email*
+01 (USA) +91 (IND) +61 (AUS) +64 (NZL) +92 (PAK)

Your information will be shared with the office you are requesting appointment
with and stored in your user profile

{{message}}
{{message}}
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AS PART OF MY USE OF HEALTHSOUL, I ACKNOWLEDGE THE USE OF MY INFORMATION WILL BE
PROCESSED IN ACCORDANCE WITH THE HEALTHSOUL PRIVACY POLICY AND TERMS OF SERVICE.
BY CLICKING "ACCEPT", I AM HEREBY PROVIDING CONSENT TO THIS USE AND AGREE TO ALL
OF THE TERMS AND CONDITIONS.

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SUBSCRIBE TO OUR NEWSLETTER

www.healthsoul.com Open in urlscan Pro 52.204.12.109 Public Scan

Form analysis 3 forms found in the DOM

POST

POST

POST

Text Content

www.healthsoul.com Open in urlscan Pro
52.204.12.109 Public Scan

Form analysis
3 forms found in the DOM