client.kakirasugarltdvetclinic.com Open in urlscan Pro
46.101.72.117  Public Scan

Form analysis
2 forms found in the DOM

POST login

<form action="login" method="post">
  <div class="input-group mb-3">
    <!-- <select name="code" required style="width:60px;">
            </select>-->
    <input style="width:40px;" type="text" readonly="" value="254">
    <input type="tel" class="form-control" minlength="9" maxlength="9" required="" name="username" placeholder="7XXXXXXXX" style="border-radius:20px;border:1px solid #824808;">
    <div class="input-group-append">
      <div class="input-group-text">
        <span class="fas fa-user"></span>
      </div>
    </div>
  </div>
  <div class="input-group mb-3">
    <input type="email" class="form-control" minlength="3" required="" name="email" placeholder="me@example.com" style="border-radius:20px;border:1px solid #824808;">
    <div class="input-group-append">
      <div class="input-group-text">
        <span class="fas fa-at"></span>
      </div>
    </div>
  </div>
  <!-- <div class="input-group mb-3">
          <input type="password" class="form-control" required name="password" placeholder="Password">
          <div class="input-group-append">
            <div class="input-group-text">
              <span class="fas fa-lock"></span>
            </div>
          </div>
        </div>-->
  <div class="row">
    <div class="col-8">
      <div class="icheck-primary">
        <input type="checkbox" id="remember">
        <label for="remember"> Remember Me </label>
      </div>
    </div>
    <!-- /.col -->
    <div class="col-4">
      <button type="submit" class="btn btn-primary btn-sm btn-block">Sign In</button>
    </div>
    <!-- /.col -->
  </div>
</form>

POST appon

<form action="appon" method="post">
  <div class="row">
    <div class="col-6"> Name:<input class="form-control" type="text" placeholder="Full Name" name="name" minlength="8" required="">
    </div>
    <div class="col-6"> Phone Number:<input class="form-control" type="text" placeholder="Phone Number" minlength="8" name="phone" required="">
    </div>
    <div class="col-6"> Email Address:<input class="form-control" type="text" placeholder="Email@me.com" minlength="8" name="email" required="">
    </div>
    <div class="col-6"> Pet Name(s):<input class="form-control" type="text" placeholder="Pet/Animal Name(s)" minlength="2" name="pname" required="">
    </div>
    <div class="col-6"> Date &amp; time:<input class="form-control" type="datetime-local" placeholder="Name" name="date" required="">
    </div>
    <div class="col-6"> Service Booked: <select class="form-control select2 select2-hidden-accessible" required="" name="service" multiple="" data-placeholder="Select service" style="width: 100%;" data-select2-id="1" tabindex="-1" aria-hidden="true">
        <option>Defined below</option>
      </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="2" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--multiple" role="combobox"
            aria-haspopup="true" aria-expanded="false" tabindex="-1" aria-disabled="false">
            <ul class="select2-selection__rendered">
              <li class="select2-search select2-search--inline"><input class="select2-search__field" type="search" tabindex="0" autocomplete="off" autocorrect="off" autocapitalize="none" spellcheck="false" role="searchbox" aria-autocomplete="list"
                  placeholder="Select service" style="width: 0px;"></li>
            </ul>
          </span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
    </div>
    <div class="col-6"> Comment:<textarea name="com" minlength="8" class="form-control" required=""></textarea>
    </div>
    <div class="col-6"> Urgency of service:<select class="form-control select2 select2-hidden-accessible" name="urgency" data-placeholder="Select urgency level" style="width: 100%;" data-select2-id="3" tabindex="-1" aria-hidden="true">
        <option value="1" data-select2-id="5">Normal</option>
        <option value="2">Medium</option>
        <option value="3">Major</option>
        <option value="4">Critical</option>
      </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="4" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
            aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-labelledby="select2-urgency-84-container"><span class="select2-selection__rendered" id="select2-urgency-84-container" role="textbox" aria-readonly="true"
              title="Normal">Normal</span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
    </div>
    <div class="col-6"> &nbsp;<br><input class="btn btn-info" type="submit" name="sub" value="Book Now">
    </div>
  </div>
</form>

Text Content

ZAMBEZI CABIN RESORT
 *       Mai Mahiu


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Name:
Phone Number:
Email Address:
Pet Name(s):
Date & time:
Service Booked: Defined below
 * 

Comment:
Urgency of service: Normal Medium Major Critical Normal
 

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