qa.lifeqisystem.com Open in urlscan Pro
13.41.152.130  Public Scan

Form analysis
1 forms found in the DOM

POST ./

<form method="POST" action="./" data-hs-cf-bound="true">
  <h2>Tell us about you</h2>
  <div class="field-row">
    <label for="firstName">Please tell us your first name</label>
    <input type="text" name="firstName" id="firstName" class="u_mg-b-1-3" placeholder="Your first name..." required="" value="">
  </div>
  <div class="field-row">
    <label for="lastName">Please tell us your last name</label>
    <input type="text" name="lastName" id="lastName" class="u_mg-b-1-3" placeholder="Your last name..." required="" value="">
  </div>
  <div class="field-row">
    <label for="emailAddress">Please tell us your work email address</label>
    <input type="email" name="emailAddress" id="emailAddress" class="u_mg-b-1-3" placeholder="Your email address..." required="" value="nemadi@phcc.gov.qa">
  </div>
  <div class="SD_record--controls field-row">
    <button class="button--primary signup-confirm--button signup-button"> Continue <svg class="icon">
        <use xlink:href="#icon-arrowright"></use>
      </svg>
    </button>
    <input type="hidden" name="lifecyclestage" id="lifecyclestage" value="subscriber">
  </div>
</form>

Text Content

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WARNING


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In order to get the best experience from Life please enable Javascript in your
browser's settings.


TELL US ABOUT YOU

Please tell us your first name
Please tell us your last name
Please tell us your work email address
Continue
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