registration.glazierclinics.com Open in urlscan Pro
13.32.121.57  Public Scan

Form analysis
1 forms found in the DOM

POST https://registration.glazierclinics.com/login

<form method="POST" action="https://registration.glazierclinics.com/login">
  <input type="hidden" name="_token" value="SKVuKNThknZHlM4kLjgQlDcQL58h0UC9zdpMQ4lt">
  <div class="form-group">
    <label>Email</label>
    <input class="form-control form-control-lg" type="email" name="email" placeholder="Enter your email">
  </div>
  <div class="form-group">
    <label>Password</label>
    <input class="form-control form-control-lg" type="password" name="password" placeholder="Enter your password">
    <small>
      <a href="https://registration.glazierclinics.com/forgot-password">Forgot password?</a>
    </small>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" value="remember" name="remember" id="remember" checked="">
    <label class="form-check-label" for="defaultCheck1"> Remember me next time </label>
  </div>
  <div class="text-center mt-3">
    <button type="submit" class="btn btn-lg btn-secondary w-100" style="font-family: 'Archivo Black';">SIGN IN</button>
  </div>
  <br>
</form>

Text Content

Email
Password Forgot password?
Remember me next time
SIGN IN


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

FORGOT PASSWORD?