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engage.patientaccesscollaborative.net Open in urlscan Pro
154.27.66.81  Public Scan

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Submitted URL: https://engage.patientaccesscollaborative.net/forum/3695&lt
Effective URL: https://engage.patientaccesscollaborative.net/account/loginaux?ReturnUrl=%2fforum%2f3695%26lt&require=LoggedIn
Submission: On November 01 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST /account/loginaux

<form action="/account/loginaux" method="post" class="form-horizontal" enctype="multipart/form-data">
  <input name="__RequestVerificationToken" type="hidden" value="qk_6XxSbTEKYeJSN31bjUVg3T_S3KMZNt-nsJTKr1YVAyjL4zRqy_-0XNy5LzSWftIVgLgDFax3Ap9nhun9GszsuNDzKAhz0HyyR2JlugNA1"><input id="ReturnUrl" name="ReturnUrl" type="hidden"
    value="/forum/3695&amp;lt">
  <div class="loginAuxForm mb20">
    <h2>Password-less Login</h2>
    <p class="alert alert-info"> If you have issues remembering your PAC password, enter your email address associated with your PAC member account below, then click "Get Access Code" to retrieve your access code. </p>
    <p class="alert alert-success hide email-code">Success! Access Code has been sent to your email. Please check your junk folder if you do not see the email.</p>
    <p class="alert alert-warning hide email-fail">Sorry, we have no record for that account.</p>
    <p class="alert alert-warning hide email-brute">Please wait 1 minute before requesting the access code again.</p>
    <div class="row">
      <div class="col-xs-12">
        <div class="alert-required form-group">
          <label class="control-label col-sm-3" for="username">E-mail</label>
          <div class="col-sm-5">
            <div class="input-group">
              <input class="form-control username" id="username" name="username" type="text" value="">
              <span class="input-group-btn">
                <button type="button" name="getcode" value="getcode" class="btn btn-primary getaccesscode">Get Access Code</button>
              </span>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-xs-12">
        <div class="alert-required form-group">
          <label class="control-label col-sm-3" for="accesscode">Access Code</label>
          <div class="col-sm-5">
            <input class="form-control" id="accesscode" name="accesscode" type="password" value="">
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-offset-3 pl10">
        <button type="submit" class="btn btn-primary" name="login" value="login">Login</button>
      </div>
    </div>
  </div>
</form>

Text Content

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Back
 1. 
 2. Home
 3. Log In


PAC MEMBER LOGIN

If you would like to login using your PAC username and password, click the
button below to proceed.

Website Login


PASSWORD-LESS LOGIN

If you have issues remembering your PAC password, enter your email address
associated with your PAC member account below, then click "Get Access Code" to
retrieve your access code.

Success! Access Code has been sent to your email. Please check your junk folder
if you do not see the email.

Sorry, we have no record for that account.

Please wait 1 minute before requesting the access code again.

E-mail
Get Access Code
Access Code

Login

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