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Form analysis
2 forms found in the DOM

POST /create-contact.php

<form id="contact-form" class="contact__form" method="post" action="/create-contact.php">
  <div class="row">
    <div class="col-6 mt-3">
      <input type="text" id="name" name="name" class="form-control" placeholder="Full name">
    </div>
    <div class="col-6 mt-3">
      <input type="email" id="email" name="email" class="form-control" placeholder="Email address">
    </div>
    <div class="col-6 mt-3">
      <input type="text" id="dob" name="dob" class="form-control" placeholder="Your Date of Birth">
    </div>
    <div class="col-6 mt-3">
      <input type="text" id="phone" name="phone_number" class="form-control" placeholder="Phone number">
    </div>
    <div class="col-6 mt-3">
      <input type="text" id="state" name="state" class="form-control" placeholder="Your State">
    </div>
    <div class="col-6 mt-3">
      <input type="text" id="city" name="city" class="form-control" placeholder="Your City">
    </div>
    <div class="col-12 mt-3">
      <textarea id="street" name="street" class="form-control" rows="5" placeholder="Your street"></textarea>
    </div>
    <div class="col-12 mt-3">
      <input type="checkbox" name="agreement" value="1"> I agree , By submitting my cell phone number to receive automated sms/mms messages with more information or quote from BUTTERFLY HEALTH. Message frequency may vary. Reply STOP to cancel, Reply
      HELP for contact information. message and date rates may apply <a href="terms-conditions.html">Terms &amp; Conditions</a> | <a href="privacy-policy.html">Privacy Policy</a>
    </div>
    <div class="col-12 mt-3 text-center">
      <button type="submit" class="btn btn-primary">Send</button>
    </div>
  </div>
</form>

POST /opt-contact.php

<form method="POST" action="/opt-contact.php">
  <div class="modal-body"><input type="text" class="form-control" placeholder="Phone" name="ph" required="">
  </div>
  <div class="modal-footer">
    <button type="button" class="btn btn-secondary closeModalButton">Close</button>
    <button type="submit" class="btn btn-primary">Submit</button>
  </div>
</form>

Text Content

Call : +13473235649 nicolenvhealthadvisor@gmail.com
BUTTERFLY HEALTH
 * Home(current)
 * Terms Conditions(current)
 * Privacy Policy(current)


BUTTERFLY HEALTH


NICOLE NIEVES VASQUEZ

I am a licensed healthcare advisor and a one-stop shop for all health insurance
needs. From finding the right affordable health coverage option to meet the
needs and budget of every family and individual I assist, to ensuring their
choice of plan is secure and active for them.


WHAT WE OFFER

TAILORED INSURANCE PLANS

Let us help you find the perfect health insurance coverage for your specific
needs and budget.

SECURE PLAN ACTIVATION

We make sure that your chosen plan is activated and ready to use, giving you
peace of mind and security.

EXPERT HEALTHCARE ADVICE

Get personalized guidance from a licensed healthcare advisor on all your
insurance queries and concerns.


HOW TO REACH US

I agree , By submitting my cell phone number to receive automated sms/mms
messages with more information or quote from BUTTERFLY HEALTH. Message frequency
may vary. Reply STOP to cancel, Reply HELP for contact information. message and
date rates may apply Terms & Conditions | Privacy Policy
Send

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