www.payspanhealth.com Open in urlscan Pro
209.34.236.225  Public Scan

Form analysis
1 forms found in the DOM

POST /NPS/Login

<form action="/NPS/Login" method="post">
  <div class="validation-summary-valid alert alert-danger" data-valmsg-summary="true">
    <ul>
      <li style="display:none"></li>
    </ul>
  </div>
  <div class="row form-group">
    <div class="col-sm-12 form-group">
      <label for="Username">Username</label>
      <input autocomplete="off" class="form-control" data-val="true" data-val-required="User name is Required" id="Username" name="Username" type="text" value="">
    </div>
  </div>
  <div class="row form-group">
    <div class="col-sm-12 form-group">
      <label for="Password">Password</label>
      <input autocomplete="new-password" class="form-control" data-val="true" data-val-required="Password is Required" id="Password" name="Password" type="password">
    </div>
  </div>
  <div class="row">
    <div class="col-xs-6 col-md-4 form-group">
      <button type="submit" class="btn btn-sm btn-ps">Login</button>
    </div>
    <div class="col-xs-6 col-md-8 form-group"> &nbsp; </div>
  </div>
  <div class="row form-group">
    <div class="col-sm-4">
      <a href="/providerportal/registration" class="btn btn-sm btn-ps">Register</a>
    </div>
    <div class="col-sm-8">
      <div class="checkbox">
        <small class="hidden-xs hidden-sm text-muted"> The registration process on our site is secure, free and fast! </small>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-sm-12">
      <ul class="links">
        <li><a href="/NPS/Password/Forgot">Forgot your Username or Password?</a></li>
        <li><a href="/NPS/Support/Index">Need more help?</a></li>
      </ul>
    </div>
  </div>
  <input id="url-hash" name="UrlHash" type="hidden" value=""> <input type="hidden" id="ipAdminNotify">
</form>

Text Content

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