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Submitted URL: https://helpdesk.doctor.com/
Effective URL: https://www.tfaforms.com/4821473
Submission: On August 01 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://www.tfaforms.com/4821473
Submission: On August 01 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
POST https://www.tfaforms.com/api_v2/workflow/processor
<form method="post" action="https://www.tfaforms.com/api_v2/workflow/processor" class="hintsBelow labelsAbove" id="4821473" role="form" enctype="multipart/form-data">
<div class="htmlSection" id="tfa_52">
<div class="htmlContent" id="tfa_52-HTML"><span style="font-size: 14px; text-align: right;">
Form updated 1/26/22 </span></div>
</div>
<div class="htmlSection" id="tfa_38">
<div class="htmlContent" id="tfa_38-HTML"><span style="font-weight: 700; font-size: 14px;">ATTENTION: </span><span style="font-size: 14px;">This form is </span><i>not</i><span style="font-size: 14px;"> configured to handle patient
data. Please <i>do not</i> submit Protected Health Information (PHI) through this form. If sharing PHI is required for your request, please note that in the description and further instructions will be provided to you for secure submittal of
PHI.</span></div>
</div>
<fieldset id="tfa_19" class="section">
<legend id="tfa_19-L">Contact</legend>
<div id="tfa_36" class="section inline group">
<div class="oneField field-container-D " id="tfa_21-D">
<label id="tfa_21-L" class="label preField reqMark" for="tfa_21">Organization Name</label><br>
<div class="inputWrapper"><input aria-required="true" type="text" id="tfa_21" name="tfa_21" value="" title="Organization Name" class="required"></div>
</div>
<div class="oneField field-container-D " id="tfa_18-D">
<label id="tfa_18-L" class="label preField reqMark" for="tfa_18">First and Last Name</label><br>
<div class="inputWrapper"><input aria-required="true" type="text" id="tfa_18" name="tfa_18" value="" title="First and Last Name" class="required"></div>
</div>
</div>
<div class="oneField field-container-D " id="tfa_8-D">
<label id="tfa_8-L" class="label preField reqMark" for="tfa_8">Email Address</label><br>
<div class="inputWrapper"><input aria-required="true" type="text" id="tfa_8" name="tfa_8" value="" title="Email Address" class="validate-email required"></div>
</div>
<div class="oneField field-container-D " id="tfa_40-D" role="group" aria-labelledby="tfa_40-L" data-tfa-labelledby="-L tfa_40-L">
<label id="tfa_40-L" class="label preField " data-tfa-check-label-for="tfa_40">Please select this option if you want other folks in your organization to be copied on this inquiry</label><br>
<div class="inputWrapper"><span id="tfa_40" class="choices vertical "><span class="oneChoice"><input type="checkbox" value="tfa_41" class="" id="tfa_41" name="tfa_41" data-conditionals="#tfa_42" aria-labelledby="tfa_41-L"
data-tfa-labelledby="tfa_40-L tfa_41-L" data-tfa-parent-id="tfa_40"><label class="label postField" id="tfa_41-L" for="tfa_41"><span class="input-checkbox-faux"></span>Add additional emails</label></span></span></div>
</div>
<fieldset id="tfa_42" class="section offstate" data-condition="`#tfa_41`">
<div id="tfa_45" class="section inline group">
<div class="oneField field-container-D " id="tfa_43-D">
<label id="tfa_43-L" class="label preField " for="tfa_43">First additional email</label><br>
<div class="inputWrapper"><input type="text" id="tfa_43" name="tfa_43" value="" title="First additional email" class="validate-email" disabled=""></div>
</div>
<div class="oneField field-container-D " id="tfa_44-D">
<label id="tfa_44-L" class="label preField " for="tfa_44">Second additional email</label><br>
<div class="inputWrapper"><input type="text" id="tfa_44" name="tfa_44" value="" title="Second additional email" class="validate-email" disabled=""></div>
</div>
</div>
<div class="oneField field-container-D " id="tfa_46-D">
<label id="tfa_46-L" class="label preField " for="tfa_46">Third additional email</label><br>
<div class="inputWrapper"><input type="text" id="tfa_46" name="tfa_46" value="" title="Third additional email" class="validate-email" disabled=""></div>
</div>
</fieldset>
</fieldset>
<fieldset id="tfa_20" class="section">
<legend id="tfa_20-L">Description</legend>
<div class="oneField field-container-D hintsBelow " id="tfa_4-D" role="radiogroup" aria-labelledby="tfa_4-L" data-tfa-labelledby="-L tfa_4-L">
<label id="tfa_4-L" class="label preField reqMark" data-tfa-check-label-for="tfa_4"><b>Please select the statement below that best represents your request. </b></label><br>
<div class="inputWrapper"><span id="tfa_4" class="choices vertical required"><span class="oneChoice"><input type="radio" value="tfa_32" class="" id="tfa_32" name="tfa_4" aria-required="true" aria-labelledby="tfa_32-L"
data-tfa-labelledby="tfa_4-L tfa_32-L" data-tfa-parent-id="tfa_4"><label class="label postField" id="tfa_32-L" for="tfa_32"><span class="input-radio-faux"></span><span
style="color: rgb(8, 7, 7); font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 14px; background-color: rgb(255, 255, 255);">I
have a general question or request</span></label></span><span class="oneChoice"><input type="radio" value="tfa_33" class="" id="tfa_33" name="tfa_4" aria-required="true" aria-labelledby="tfa_33-L"
data-tfa-labelledby="tfa_4-L tfa_33-L" data-tfa-parent-id="tfa_4"><label class="label postField" id="tfa_33-L" for="tfa_33"><span class="input-radio-faux"></span><span
style="color: rgb(8, 7, 7); font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 14px; background-color: rgb(255, 255, 255);">I
need help fixing something that is not quite right</span></label></span><span class="oneChoice"><input type="radio" value="tfa_34" class="" id="tfa_34" name="tfa_4" aria-required="true" aria-labelledby="tfa_34-L"
data-tfa-labelledby="tfa_4-L tfa_34-L" data-tfa-parent-id="tfa_4"><label class="label postField" id="tfa_34-L" for="tfa_34"><span class="input-radio-faux"></span><span
style="color: rgb(8, 7, 7); font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 14px; background-color: rgb(255, 255, 255);">I
have a critical need with no solution available</span></label></span><span class="oneChoice"><input type="radio" value="tfa_35" class="" id="tfa_35" name="tfa_4" aria-required="true" aria-labelledby="tfa_35-L"
data-tfa-labelledby="tfa_4-L tfa_35-L" data-tfa-parent-id="tfa_4"><label class="label postField" id="tfa_35-L" for="tfa_35"><span class="input-radio-faux"></span><span
style="color: rgb(8, 7, 7); font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 14px; background-color: rgb(255, 255, 255);">I
have an outage of service or the system is down</span></label></span></span></div>
</div>
<div class="oneField field-container-D " id="tfa_9-D" role="radiogroup" aria-labelledby="tfa_9-L" data-tfa-labelledby="-L tfa_9-L">
<label id="tfa_9-L" class="label preField reqMark" data-tfa-check-label-for="tfa_9"><b>Identify the source of the issue or question. </b><span style="font-weight: 700; font-size: 14px;">If your inquiry spans multiple products, please
submit a separate request for each product.</span></label><br>
<div class="inputWrapper"><span id="tfa_9" class="choices vertical required"><span class="oneChoice"><input type="radio" value="tfa_25" class="calc-IdentifySource calcval-Listings" id="tfa_25" name="tfa_9" aria-required="true"
aria-labelledby="tfa_25-L" data-tfa-labelledby="tfa_9-L tfa_25-L" data-tfa-parent-id="tfa_9"><label class="label postField" id="tfa_25-L" for="tfa_25"><span class="input-radio-faux"></span>Listings Management </label></span><span
class="oneChoice"><input type="radio" value="tfa_26" class="calc-IdentifySource calcval-Reputation Insights" id="tfa_26" name="tfa_9" aria-required="true" aria-labelledby="tfa_26-L" data-tfa-labelledby="tfa_9-L tfa_26-L"
data-tfa-parent-id="tfa_9"><label class="label postField" id="tfa_26-L" for="tfa_26"><span class="input-radio-faux"></span>Reputation Management</label></span><span class="oneChoice"><input type="radio" value="tfa_27"
class="calc-IdentifySource calcval-Transparency" id="tfa_27" name="tfa_9" aria-required="true" aria-labelledby="tfa_27-L" data-tfa-labelledby="tfa_9-L tfa_27-L" data-tfa-parent-id="tfa_9"><label class="label postField" id="tfa_27-L"
for="tfa_27"><span class="input-radio-faux"></span>Transparency</label></span><span class="oneChoice"><input type="radio" value="tfa_24" class="calc-IdentifySource calcval-DataManager" id="tfa_24" name="tfa_9" aria-required="true"
aria-labelledby="tfa_24-L" data-tfa-labelledby="tfa_9-L tfa_24-L" data-tfa-parent-id="tfa_9"><label class="label postField" id="tfa_24-L" for="tfa_24"><span class="input-radio-faux"></span>DataManager</label></span><span
class="oneChoice"><input type="radio" value="tfa_28" class="calc-IdentifySource calcval-Find-A-Doc" id="tfa_28" name="tfa_9" aria-required="true" aria-labelledby="tfa_28-L" data-tfa-labelledby="tfa_9-L tfa_28-L"
data-tfa-parent-id="tfa_9"><label class="label postField" id="tfa_28-L" for="tfa_28"><span class="input-radio-faux"></span>Find-A-Doctor Directory </label></span><span class="oneChoice"><input type="radio" value="tfa_30"
class="calc-IdentifySource calcval-ReviewRequest" id="tfa_30" name="tfa_9" aria-required="true" aria-labelledby="tfa_30-L" data-tfa-labelledby="tfa_9-L tfa_30-L" data-tfa-parent-id="tfa_9"><label class="label postField" id="tfa_30-L"
for="tfa_30"><span class="input-radio-faux"></span>Campaigns</label></span><span class="oneChoice"><input type="radio" value="tfa_17" class="calc-IdentifySource calcval-Other" id="tfa_17" name="tfa_9" aria-required="true"
aria-labelledby="tfa_17-L" data-tfa-labelledby="tfa_9-L tfa_17-L" data-tfa-parent-id="tfa_9"><label class="label postField" id="tfa_17-L" for="tfa_17"><span class="input-radio-faux"></span>Other</label></span></span></div>
</div>
<div class="oneField field-container-D " id="tfa_50-D">
<label id="tfa_50-L" class="label preField reqMark" for="tfa_50"><b>Subject</b></label><br>
<div class="inputWrapper">
<div><textarea aria-required="true" maxlength="1000" id="tfa_50" name="tfa_50" title="Subject" class="required"></textarea>
<div class="lengthIndicator" aria-live="assertive" style="display: none; left: 631px;">1000 characters left.</div>
</div>
</div>
</div>
<div class="oneField field-container-D " id="tfa_1-D">
<label id="tfa_1-L" class="label preField reqMark" for="tfa_1"><b>Description</b></label><br>
<div class="inputWrapper">
<div><textarea aria-required="true" maxlength="31900" id="tfa_1" name="tfa_1" title="Description" class="required"></textarea>
<div class="lengthIndicator" aria-live="assertive" style="display: none; left: 636px;">31900 characters left.</div>
</div>
</div>
</div>
<div class="oneField field-container-D repeat " id="tfa_39-D" data-repeatlimit="10" data-repeatlabel="Attach another file" wfr_handled="true">
<label id="tfa_39-L" class="label preField " for="tfa_39"><b>Attachments</b>:</label><br>
<div class="inputWrapper"><input type="file" id="tfa_39" name="tfa_39" size="" title="Attachments:" class=""></div>
</div>
<div class="duplicateSpan"><a id="tfa_39-D-wfDL" href="#" class="duplicateLink" title="Will duplicate this question or section.">Attach another file</a></div>
</fieldset>
<div class="actions" id="4821473-A" data-contentid="submit_button"><input type="submit" data-label="Submit" class="primaryAction" id="submit_button" value="Submit"></div>
<div style="clear:both"></div>
<input type="hidden" value="517-cc243971792b6741ee2bad0e9a6abb6b" name="tfa_dbCounters" id="tfa_dbCounters" autocomplete="off"><input type="hidden" value="4821473" name="tfa_dbFormId" id="tfa_dbFormId"><input type="hidden" value=""
name="tfa_dbResponseId" id="tfa_dbResponseId"><input type="hidden" value="919e1cde88b71f6fc4ac2bc9fe940e4e" name="tfa_dbControl" id="tfa_dbControl"><input type="hidden" value="" name="tfa_dbWorkflowSessionUuid"
id="tfa_dbWorkflowSessionUuid"><input type="hidden" value="" name="tfa_noOverWriteFields" id="tfa_noOverWriteFields"><input type="hidden" value="1722510350" name="tfa_dbTimeStarted" id="tfa_dbTimeStarted" autocomplete="off"><input type="hidden"
value="54" name="tfa_dbVersionId" id="tfa_dbVersionId"><input type="hidden" value="tfa_42" name="tfa_switchedoff" id="tfa_switchedoff">
</form>Text Content
SUPPORT CASE SUBMISSION Form updated 1/26/22 ATTENTION: This form is not configured to handle patient data. Please do not submit Protected Health Information (PHI) through this form. If sharing PHI is required for your request, please note that in the description and further instructions will be provided to you for secure submittal of PHI. Contact Organization Name First and Last Name Email Address Please select this option if you want other folks in your organization to be copied on this inquiry Add additional emails First additional email Second additional email Third additional email Description Please select the statement below that best represents your request. I have a general question or requestI need help fixing something that is not quite rightI have a critical need with no solution availableI have an outage of service or the system is down Identify the source of the issue or question. If your inquiry spans multiple products, please submit a separate request for each product. Listings Management Reputation ManagementTransparencyDataManagerFind-A-Doctor Directory CampaignsOther Subject 1000 characters left. Description 31900 characters left. Attachments: Attach another file