stagecentura.workstride.net Open in urlscan Pro
52.5.223.39  Public Scan

Form analysis
4 forms found in the DOM

POST /login

<form id="loginForm" action="/login" method="post">
  <div class="form-group">
    <label for="username" class="form-control-label">Email Address</label>
    <input type="text" id="username" class="form-control" name="username">
  </div>
  <div class="form-group">
    <label for="password" class="form-control-label">Password</label>
    <input autocomplete="false" type="password" id="password" class="form-control" name="password">
  </div>
  <div class="form-group">
    <a href="#" id="passwordSelect" class="overlayTrigger forgot-password-link">Forgot Password</a>
  </div>
  <div class="form-group">
    <input type="submit" id="loginSubmit" class="loginSignIn btn-signin" value="Sign In">
  </div>
</form>

<form id="forgotPassword"> Email <input type="text" id="email" name="email" maxlength="75" style="border: 1px solid #bbb;" placeholder="Please enter email">
  <br><br>
  <input type="submit" id="forgotPasswordSubmit" value="Continue">
</form>

<form id="firstTimeForm">
  <div>
    <label>First Name</label>
    <span class="required-asterisk">*</span>
    <input type="text" name="first_name" class="form-control" required="">
  </div>
  <div>
    <label>Last Name</label>
    <span class="required-asterisk">*</span>
    <input type="text" name="last_name" class="form-control" required="">
  </div>
  <div>
    <label>Centura Health User ID</label>
    <span class="required-asterisk">*</span>
    <input type="text" name="login" class="form-control" required="">
  </div>
  <div>
    <label>Email Address</label>
    <span class="required-asterisk">*</span>
    <input type="text" name="email" class="form-control" required="">
    <label>Please use your @centura.org email.</label>
  </div>
  <br class="clear">
  <div class="alignLeft">
    <br>
    <div class="alignCenter">
      <button type="submit">Register</button>
    </div>
  </div>
</form>

<form id="regForm">
  <div class="b1o2 content">
    <label> First Name </label>
    <br>
    <input id="first_name" name="first_name" type="text">
  </div>
  <div class="b1o2 content">
    <label> Last Name </label>
    <br>
    <input id="last_name" name="last_name" type="text">
  </div>
  <br class="clear">
  <div class="b1o3 content">
    <label> Email </label>
    <br>
    <input id="email_address" name="email_address" type="text">
  </div>
  <div class="b1o3 content">
    <label> New Password </label>
    <br>
    <input id="email_address" name="email_address" type="text">
  </div>
  <div class="b1o3 content">
    <label> Confirm Password </label>
    <br>
    <input id="email_address" name="email_address" type="text">
  </div>
  <div>
    <label> Street Address </label>
    <br>
    <input id="address1" name="address1" type="text">
  </div>
  <div class="b2o6 content">
    <label> City </label>
    <input id="city" name="city" type="text">
  </div>
  <div class="b1o6 content">
    <label> State </label>
    <select name="state">
      <option value="newyork"> NY </option>
      <option value="newjersey"> NJ </option>
    </select>
  </div>
  <div class="b1o6 content">
    <label> Zip </label>
    <br>
    <input id="zip" name="zip" type="text">
  </div>
  <div class="b2o6 content">
    <label> Country </label>
    <select name="country">
      <option value="unitedstates"> United States </option>
      <option value="canada"> Canada </option>
    </select>
  </div>
  <br class="clear">
  <div class="alignLeft">
    <label>
      <input type="checkbox" tabindex="12"> &nbsp; &nbsp; By setting up this account, you are agreeing to our <a href="##">terms</a> and <a href="##">privacy policy</a>. </label>
    <br>
    <br>
    <label>
      <input type="checkbox" tabindex="13"> &nbsp; &nbsp; No, I do not want to receive the Promotional Email. </label>
    <br>
    <br>
    <div class="alignCenter">
      <button type="submit"> Register </button>
    </div>
  </div>
</form>

Text Content

Email Address
Password
Forgot Password





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First Name *
Last Name *
Centura Health User ID *
Email Address * Please use your @centura.org email.



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First Name

Last Name


Email

New Password

Confirm Password

Street Address

City
State NY NJ
Zip

Country United States Canada

    By setting up this account, you are agreeing to our terms and privacy
policy.

    No, I do not want to receive the Promotional Email.


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