app.chartrequest.com
Open in
urlscan Pro
54.165.196.64
Public Scan
Submitted URL: http://url493.chartrequest.com/ls/click?upn=n1fevB6hHGmbjfdWjqBNrVFuD7hj7yFwmQZu-2FJ4JZHT08yuqeX3j78-2BRK18gSL32mmlfnrMC43ikK4E...
Effective URL: https://app.chartrequest.com/login
Submission: On October 10 via manual from US — Scanned from DE
Effective URL: https://app.chartrequest.com/login
Submission: On October 10 via manual from US — Scanned from DE
Form analysis
1 forms found in the DOMPOST /login
<form class="new_login_form" action="/login" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓"><input type="hidden" name="authenticity_token"
value="3bhl0nLKoDDrWlgjnKnRaDel/8dzmjfi18hz4ZJn8+MZ5F9vcy6GEZGRqg1qxvxaveCK0BVody1seO1sfl7B3w==">
<div class="col-sm-12" style="padding: 5px 0">
<label class="email-pwd-filed">Email Address <input type="text" name="login" id="login" value="" placeholder="Required" class="form-control" style="margin-top: 10px" required="required">
</label>
</div>
<div class="col-sm-12" style="padding: 5px 0">
<div class="password-validation-div">
<label class="email-pwd-filed">Password <span id="pswd-valid" style="display: none"><img src="https://assets.chartrequest.com/assets/custom-icons/icon-checkgreen-74ec182742ae6cb236af077a0f954dfe7392ef2484e310bdbda8d9a6ad2d0d90.png"></span>
<input type="password" name="password" id="user_password" class="form-control" placeholder="Required" style="margin-top: 10px">
</label>
<div id="pswd_info">
<p class="w600 f15">Password must meet 3 of 4 requirements:</p>
<ul>
<li id="length" class="invalid">Minimum 8 characters</li>
<li id="letter" class="invalid">At least one lowercase letter (a-z)</li>
<li id="capital" class="invalid">At least one capital letter (A-Z)</li>
<li id="number" class="invalid">At least one number (0-9)</li>
<li id="symbol" class="invalid">At least one symbol (!@#$%^&*)</li>
</ul>
</div>
</div>
</div>
<div class="remove-padding login-remember-forgot">
<label style="font-weight: 300"><input type="checkbox" name="remember_me" id="remember_me" value="1" style="margin-right: 5px">Remember Me</label>
<a href="" data-toggle="modal" data-target="#reset-password" class="pull-right">Forgot Password?</a>
<p class="remember-me-warning-msg text-error w600" style="display: none;"><i class="fa fa-info-circle" aria-hidden="true"></i>Enabling Remember Me is not recommended if there are multiple users on this device.</p>
</div>
<button name="button" type="submit" class="btn-login btn custom_btn_primary"> Log in </button>
</form>
Text Content
ChartRequest works best in the Google Chrome Web Browser. Download it here. About * * About Us * Platform Benefits * Contact Us Support Sign Up Log in to start Requesting Health Information × You must be signed in to access that page Email Address Password Password must meet 3 of 4 requirements: * Minimum 8 characters * At least one lowercase letter (a-z) * At least one capital letter (A-Z) * At least one number (0-9) * At least one symbol (!@#$%^&*) Remember Me Forgot Password? Enabling Remember Me is not recommended if there are multiple users on this device. Log in Log in with Google Login with SSO or Don’t have an account? Sign up for free Sign up with Google RESET MY PASSWORD Enter your ChartRequest login email below, and we'll send you a reset password link. Send Reset Link Close RESET LINK SENT We just sent an email to Please check your spam folder if you do not receive your reset password after 1 minute. Close × REMINDER SENT! Mail has been sent. Close