secure3.surveynetwork.com Open in urlscan Pro
208.53.56.118  Public Scan

Form analysis
1 forms found in the DOM

Name: form1 — POST main.php?PHPSESSID=29882109-0a6474f3-0a6474de-0064d7ff90-00020ee26c-0000001168&cacheBust=1691877264

<form name="form1" id="form1" action="main.php?PHPSESSID=29882109-0a6474f3-0a6474de-0064d7ff90-00020ee26c-0000001168&amp;cacheBust=1691877264" method="post" onsubmit="return submitPage()">
  <noscript>
    <style>
      #customMessages {
        display: none
      }
    </style>
    <div style="margin:0 auto;display:table;text-align:center;_width:400px;">
      <img src="/media/images/headerlogo.jpg">
      <span class="instruction">
        <h1>Please enable your javascript to continue with this survey</h1>
      </span>
    </div>
  </noscript>
  <div id="customMessages" class="customMessages small" align="center" style="display: none;">Please wait while page is being loaded.</div>
  <div class="main" style="display: block;">
    <div class="header" align="center">
      <div><img id="headerLogo" oncontextmenu="return false"></div> <!-- HEADERLOGO -->
      <div class="statusBar">
        <table>
          <tbody>
            <tr>
              <td align="right">Start</td>
              <td class="progressBar" align="center">
                <div style="width:190px;height:12px;background:#fff;text-align:left;">
                  <div style="height:100%;background:#90D1EF;width:0%;"></div>
                </div>
              </td>
              <td align="left">Finish</td>
            </tr>
          </tbody>
        </table>
      </div>
    </div>
    <div class="errorContainer" align="center">
    </div>
    <table align="center" class="centerDiv mainContent">
      <tbody>
        <tr>
          <td align="left">
            <p class="question">
              <i>All responses are anonymous, and results 
will only be reported in the aggregate,
  rather than for individuals.  
</i>
            </p><i>

<table width="100%" cellpadding="2" cellspacing="2" border="0" class="punchtable">
</table>


<input type="hidden" name="survey" value="29882109">
<input type="hidden" name="version" value="sms">
<input type="hidden" name="section" value="SCREENER">

<!--INSERT-->
        </i>
          </td>
        </tr>
      </tbody>
    </table>
    <div class="footer">
      <hr class="footer-sep">
      <style>
        .btn_back,
        .btn_next {
          vertical-align: middle;
        }

        .navigation {
          list-style: none;
          margin: 0 auto;
          padding: 0px;
          display: inline-block;
          position: relative;
        }

        .navigation li {
          display: inline-block;
          cursor: pointer;
        }

        .navigation li.back-navi {
          float: left;
        }

        .navigation li.next-navi {
          float: right;
        }

        .navigation li:hover {
          color: #00f;
        }
      </style>
      <ul class="navigation">
        <li class="back-navi">
          <input type="image" name="btn_back" id="btn_back" class="btn_back" src="/media/images/back_btn_v2.0.jpg" title="Previous question" onclick="goBack(event)">
          <span onclick="$('#btn_back').click()">Back</span>
        </li>
        <li class="_logo"></li>
        <li class="next-navi">
          <span id="nxtback" onclick="$('#btn_next').click()">Next</span>
          <input type="image" name="btn_next" id="btn_next" class="btn_next" src="/media/images/next_btn_v2.0.jpg" title="Next question" onclick="goNext(event)">
        </li>
      </ul>
      <p class="reminder"> During the survey, please do not use your browser's forward or Back buttons. To move through the survey, use the back or next buttons at the bottom of each page. </p>
    </div>
    <!-- start REPORT A PROBLEM -->
    <div id="others">
      <br>
      <span id="reportSentSuccess" style="display:none;font-family:Arial;font-size:8pt;padding:2px; background:#FFF1A8;">Successfully sent report.<br></span>
      <br>
      <script language="javascript">
        $(".reportaproblem").fancybox({
          autoScale: false,
          centerOnScroll: true,
          scrolling: 'no',
          autoDimensions: true,
          onStart: function() {
            $('object,embed').hide();
            $('.reportBox').css('border', '1px solid #4FB5E6');
          },
          onClosed: function() {
            $("#reportBox").val('');
            $('object,embed').show();
          }
        });
        $("[rel='srvpopup']").fancybox({
          onStart: function() {
            $('object,embed').hide();
          },
          onClosed: function() {
            $('object,embed').show();
          }
        });
        var options = {
          srvPin: '18456509',
          ams_to: ''
        }
        $('.reportaproblem').css({
          position: 'fixed',
          bottom: 0,
          right: 0
        });
      </script>
      <div style="display:none;">
      </div>
    </div>
    <!-- end REPORT A PROBLEM -->
  </div>
  <input type="hidden" name="current" value="qdisclaim">
  <input type="hidden" name="__percent" value="3">
</form>

Text Content

PLEASE ENABLE YOUR JAVASCRIPT TO CONTINUE WITH THIS SURVEY

Please wait while page is being loaded.

Start

Finish



All responses are anonymous, and results will only be reported in the aggregate,
rather than for individuals.



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

 * Back
 * 
 * Next

During the survey, please do not use your browser's forward or Back buttons. To
move through the survey, use the back or next buttons at the bottom of each
page.


Successfully sent report.