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www.virtahealth.com Open in urlscan Pro
34.251.201.224  Public Scan

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Submitted URL: http://email.virtahealth.com/NzM4LVlJSy05MzYAAAGH2CjK-1UQnohQa0DlqIWmNc2VNeZQUPEtGo_gZKJ4sx4WpyIDT7ZYhUGooLHi4XxseOFXEh0=
Effective URL: https://www.virtahealth.com/lets-talk?mkt_tok=NzM4LVlJSy05MzYAAAGH2CjK-1RCHpsrbb6YlApYwe5ZAgYgTlyN9DS8eOMmzxrdVj5w0Ag79YYEp9...
Submission: On November 02 via api from US — Scanned from DE

Form analysis 2 forms found in the DOM

<form id="mktoForm_1134" novalidate="novalidate" class="mktoForm mktoHasWidth mktoLayoutLeft" style="font-family: Helvetica, Arial, sans-serif; font-size: 13px; color: rgb(51, 51, 51); width: 1601px;">
  <style type="text/css">
    .mktoForm .mktoButtonWrap.mktoRound .mktoButton {
      color: #fff;
      border: 1px solid #a3bee2;
      -webkit-border-radius: 5px;
      -moz-border-radius: 5px;
      border-radius: 5px;
      background-color: #779dd5;
      background-image: -webkit-gradient(linear, left top, left bottom, from(#779dd5), to(#5186cb));
      background-image: -webkit-linear-gradient(top, #779dd5, #5186cb);
      background-image: -moz-linear-gradient(top, #779dd5, #5186cb);
      background-image: linear-gradient(to bottom, #779dd5, #5186cb);
      padding: 0.4em 1em;
      font-size: 1em;
    }

    .mktoForm .mktoButtonWrap.mktoRound .mktoButton:hover {
      border: 1px solid #45638c;
    }

    .mktoForm .mktoButtonWrap.mktoRound .mktoButton:focus {
      outline: none;
      border: 1px solid #45638c;
    }

    .mktoForm .mktoButtonWrap.mktoRound .mktoButton:active {
      background-color: #5186cb;
      background-image: -webkit-gradient(linear, left top, left bottom, from(#5186cb), to(#779dd5));
      background-image: -webkit-linear-gradient(top, #5186cb, #779dd5);
      background-image: -moz-linear-gradient(top, #5186cb, #779dd5);
      background-image: linear-gradient(to bottom, #5186cb, #779dd5);
    }
  </style>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="Buyer_Type__c" id="LblBuyer_Type__c" class="mktoLabel mktoHasWidth" style="width: 205px;">
          <div class="mktoAsterix">*</div>What best describes you?
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><select id="Buyer_Type__c" name="Buyer_Type__c" aria-labelledby="LblBuyer_Type__c InstructBuyer_Type__c" class="mktoField mktoHasWidth mktoRequired" aria-required="true"
          style="width: 150px;">
          <option value="">Select...</option>
          <option value="Patient">Want to be a Virta patient</option>
          <option value="Health Plan">Health Plan</option>
          <option value="Employer">Employer</option>
          <option value="Health System or Provider">Health System or Provider</option>
          <option value="Consultant">Consultant</option>
          <option value="Other">Other</option>
        </select><span id="InstructBuyer_Type__c" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoPlaceholder mktoPlaceholdereNTHealthsystembuyertype"></div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="FirstName" id="LblFirstName" class="mktoLabel mktoHasWidth" style="width: 89px;">
          <div class="mktoAsterix">*</div>First Name:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="FirstName" name="FirstName" maxlength="255" aria-labelledby="LblFirstName InstructFirstName" type="text" class="mktoField mktoTextField mktoHasWidth mktoRequired"
          aria-required="true" style="width: 150px;"><span id="InstructFirstName" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="LastName" id="LblLastName" class="mktoLabel mktoHasWidth" style="width: 91px;">
          <div class="mktoAsterix">*</div>Last Name:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="LastName" name="LastName" maxlength="255" aria-labelledby="LblLastName InstructLastName" type="text" class="mktoField mktoTextField mktoHasWidth mktoRequired"
          aria-required="true" style="width: 150px;"><span id="InstructLastName" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="Email" id="LblEmail" class="mktoLabel mktoHasWidth" style="width: 112px;">
          <div class="mktoAsterix">*</div>Email Address:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="Email" name="Email" maxlength="255" aria-labelledby="LblEmail InstructEmail" type="email" class="mktoField mktoEmailField mktoHasWidth mktoRequired"
          aria-required="true" style="width: 150px;"><span id="InstructEmail" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoPlaceholder mktoPlaceholderPhone"></div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="Title" id="LblTitle" class="mktoLabel mktoHasWidth" style="width: 77px;">
          <div class="mktoAsterix">*</div>Job Title:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="Title" name="Title" maxlength="255" aria-labelledby="LblTitle InstructTitle" type="text" class="mktoField mktoTextField mktoHasWidth mktoRequired" aria-required="true"
          style="width: 150px;"><span id="InstructTitle" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="Company" id="LblCompany" class="mktoLabel mktoHasWidth" style="width: 121px;">
          <div class="mktoAsterix">*</div>Company Name:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="Company" name="Company" maxlength="255" aria-labelledby="LblCompany InstructCompany" type="text" class="mktoField mktoTextField mktoHasWidth mktoRequired"
          aria-required="true" style="width: 150px;"><span id="InstructCompany" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoPlaceholder mktoPlaceholdereNTConsultantrequesttype"></div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoPlaceholder mktoPlaceholdereNTConsultantclientspecificsize"></div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoPlaceholder mktoPlaceholdereNTConsultantclientspecificlocation"></div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoPlaceholder mktoPlaceholdereNTConsultantgeneralsize"></div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoPlaceholder mktoPlaceholdereNTProspectivePatientQuestions"></div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoPlaceholder mktoPlaceholderNumberOfEmployees"></div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoPlaceholder mktoPlaceholdereNTHealthPlanLOB"></div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoPlaceholder mktoPlaceholderLead_Message__c"></div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoButtonRow"><span class="mktoButtonWrap mktoRound" style="margin-left: 120px;"><button type="submit" class="mktoButton">Submit</button></span></div><input type="hidden" name="formid" class="mktoField mktoFieldDescriptor"
    value="1134"><input type="hidden" name="munchkinId" class="mktoField mktoFieldDescriptor" value="738-YIK-936">
</form>

<form novalidate="novalidate" class="mktoForm mktoHasWidth mktoLayoutLeft" style="font-family: Helvetica, Arial, sans-serif; font-size: 13px; color: rgb(51, 51, 51); visibility: hidden; position: absolute; top: -500px; left: -1000px; width: 1600px;">
</form>

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