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support.plushcare.com Open in urlscan Pro
104.16.51.111  Public Scan

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Submitted URL: https://ablink.info.plushcare.com/ls/click?upn=uOJ7-2BsUDGWgk-2BZMwi7K5s0YqH-2B2912rOUGN-2BBbDBSSvkG6MT8nxmvWlHlHCgsRn-2FFD-2FRcnK...
Effective URL: https://support.plushcare.com/hc/en-us/requests/new?ticket_form_id=15446240965267
Submission: On May 04 via api from US — Scanned from DE

Form analysis 2 forms found in the DOM

GET /hc/en-us/search

<form role="search" class="search" data-search="" action="/hc/en-us/search" accept-charset="UTF-8" method="get"><input name="utf8" type="hidden" value="✓" autocomplete="off"><input type="search" name="query" id="query" placeholder="Search"
    aria-label="Search"></form>

POST /hc/en-us/requests

<form id="new_request" class="request-form" data-form="" data-form-type="request" action="/hc/en-us/requests" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓" autocomplete="off"><input type="hidden"
    name="authenticity_token" value="hc:requests:client:9M6XSoOpWl-vQb8FsjLFXA6WcPRYpfiGHuY-rYVb2T5UNlrSrjJGmK1pB-khGjunDxp-9bxoZwI-kKZAqWlVfQ" data-hc-status="ready">
  <div class="form-field select optional request_ticket_form_id"><label for="request_issue_type_select">Please choose your issue below</label>
    <a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_mrkrc7200" aria-label="Please choose your issue below" style="max-width: 100%;">Support Inquiry</a><select name="request[ticket_form_id]"
      id="request_issue_type_select" aria-label="Please choose your issue below" autofocus="autofocus" style="display: none;">
      <option data-url="https://support.plushcare.com/hc/en-us/requests/new" value="-">-</option>
      <option data-url="https://support.plushcare.com/hc/en-us/requests/new?ticket_form_id=360000873173" value="360000873173">Default Ticket Form</option>
      <option data-url="https://support.plushcare.com/hc/en-us/requests/new?ticket_form_id=15446240965267" selected="selected" value="15446240965267">Support Inquiry</option>
    </select>
  </div>
  <div class="form-field string required request_anonymous_requester_email"><label for="request_anonymous_requester_email">Your email address</label>
    <input type="text" name="request[anonymous_requester_email]" id="request_anonymous_requester_email" aria-required="true">
  </div>
  <div class="form-field string  required  request_subject">
    <label id="request_subject_label" for="request_subject">Subject</label>
    <input type="text" name="request[subject]" id="request_subject" maxlength="150" size="150" aria-required="true" aria-labelledby="request_subject_label">
  </div>
  <div class="suggestion-list" data-hc-class="searchbox" data-hc-suggestion-list="true"></div>
  <div class="form-field string  optional  request_custom_fields_15450446059155">
    <label id="request_custom_fields_15450446059155_label" for="request_custom_fields_15450446059155">What type of Support do you need?</label>
    <input type="hidden" name="request[custom_fields][15450446059155]" id="request_custom_fields_15450446059155" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Membership Questions&quot;,&quot;value&quot;:&quot;membership_questionshd&quot;},{&quot;label&quot;:&quot;Billing Questions&quot;,&quot;value&quot;:&quot;billing_questionshd&quot;},{&quot;label&quot;:&quot;Lab Questions&quot;,&quot;value&quot;:&quot;lab_questionshd&quot;},{&quot;label&quot;:&quot;Tech Issues&quot;,&quot;value&quot;:&quot;tech_issueshd&quot;},{&quot;label&quot;:&quot;Therapy Questions&quot;,&quot;value&quot;:&quot;therapy_questionshd&quot;},{&quot;label&quot;:&quot;Prescription Questions&quot;,&quot;value&quot;:&quot;prescription_questionshd&quot;},{&quot;label&quot;:&quot;Other Issue Not Listed&quot;,&quot;value&quot;:&quot;other_issue_not_listedhd&quot;}]"
      aria-required="false" aria-labelledby="request_custom_fields_15450446059155_label"
      value=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_33lesvc6x" aria-required="false" aria-labelledby="request_custom_fields_15450446059155_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field text  required  request_description">
    <label id="request_description_label" for="request_description">Description</label>
    <textarea name="request[description]" id="request_description" aria-required="true" aria-describedby="request_description_hint" aria-labelledby="request_description_label"></textarea><input type="hidden" name="request[description_mimetype]"
      id="request_description_mimetype" value="text/plain" style="display: none;" autocomplete="off">
    <p id="request_description_hint">Please enter the details of your request. A member of our support staff will respond as soon as possible.</p>
  </div>
  <script data-conditional-fields="[]"></script>
  <div class="form-field">
    <label for="request-attachments"> Attachments </label>
    <div id="upload-dropzone" class="upload-dropzone">
      <input type="file" multiple="true" id="request-attachments" data-fileupload="true" data-dropzone="upload-dropzone" data-error="upload-error" data-create-url="/hc/en-us/request_uploads" data-name="request[attachments][]"
        data-pool="request-attachments-pool" data-delete-confirm-msg="" aria-describedby="upload-error">
      <span>
        <a>Add file</a> or drop files here </span>
    </div>
    <div id="upload-error" class="notification notification-error notification-inline" style="display: none;">
      <span data-upload-error-message=""></span>
    </div>
    <ul id="request-attachments-pool" class="upload-pool" data-template="upload-template"></ul>
    <script type="text/html" id="upload-template">
      <li class="upload-item" data-upload-item>
        <a class="upload-link" target="_blank" data-upload-link></a>
        <p class="upload-path" data-upload-path></p>
        <p class="upload-path" data-upload-size></p>
        <p data-upload-issue class="notification notification-alert notification-inline" aria-hidden="true"></p>
        <span class="upload-remove" data-upload-remove></span>
        <div class="upload-progress" data-upload-progress></div>
        <input type="hidden">
      </li>
    </script>
  </div>
  <footer><input type="submit" name="commit" value="Submit"></footer>
</form>

Text Content

Submit a request
 1. PlushCare
 2. Submit a request




SUBMIT A REQUEST

Please choose your issue below Support Inquiry- Default Ticket Form Support
Inquiry
Your email address
Subject

What type of Support do you need? -
Description

Please enter the details of your request. A member of our support staff will
respond as soon as possible.

Attachments
Add file or drop files here


PlushCare