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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="col-6">
    <input type="text" id="name" name="name" class="form-control" placeholder="Full name">
  </div>
  <div class="col-6">
    <input type="email" id="email" name="email" class="form-control" placeholder="Email address">
  </div>
  <div class="col-6">
    <input type="text" id="dob" name="dob" class="form-control" placeholder="Your Date of Birth">
  </div>
  <div class="col-6">
    <input type="text" id="phone" name="phone_number" class="form-control" placeholder="Phone number">
  </div>
  <div class="col-6">
    <input type="text" id="state" name="state" class="form-control" placeholder="Your State">
  </div>
  <div class="col-6">
    <input type="text" id="city" name="city" class="form-control" placeholder="Your City">
  </div>
  <div class="col-12">
    <textarea id="street" name="street" class="form-control" rows="5" placeholder="Your street"></textarea>
  </div>
  <input type="checkbox" name="agreement" value="1" style="height: 18px;width: 18px;margin: 4px 0px 0px 15px;">
  <div style="margin: -27px 50px 16px"> I agree , By submitting my cell phone number to receive automated sms/mms messages with more information or quote from RIGHT CHOICE HEALTH LLC. 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 text-center">
    <button class="btn btn-primary w-100 py-3" type="submit">Send</button>
  </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

RIGHT CHOICE HEALTH LLC
 * Home
 * Terms Conditions
 * Privacy Policy


RIGHT CHOICE HEALTH LLC




CHRISTIAN MUNETON

As a licensed healthcare advisor, I'm devoted to ensuring all the families and
individuals I help are covered by the best and right affordable health plan of
their choice, to help them focus on the best parts of life.


EXPLORE OUR OFFERINGS

AFFORDABLE HEALTH INSURANCE PLANS

 * We offer a variety of affordable health insurance plans to ensure that you
   and your family are covered for all your healthcare needs.

PERSONALIZED HEALTHCARE ADVISOR

 * Our licensed healthcare advisors are dedicated to providing personalized
   guidance and recommendations on the best health insurance options for you and
   your loved ones.

COMPREHENSIVE COVERAGE SOLUTIONS

 * We strive to find the right coverage solutions for each individual, so they
   can focus on living their best life without worrying about unexpected medical
   expenses.


CONTACT OUR TEAM

+13853136448

christian@therightchoicehealth.com

I agree , By submitting my cell phone number to receive automated sms/mms
messages with more information or quote from RIGHT CHOICE HEALTH LLC. 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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