cloud.email.communityhealthchoice.org
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13.111.185.4
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Submitted URL: https://click.email.communityhealthchoice.org/?qs=5abd63363ede1d928973e04420f4e852feed45359c03ca2560abba6fabee1d6e37739f531ded6dec9016ae73fc8f...
Effective URL: https://cloud.email.communityhealthchoice.org/preferences?qs=c18db216b01dc055e06e5fe8efd36cc30921c77067e296c91198b222c050579374ec3a6c2c26a60ba...
Submission: On May 30 via api from US — Scanned from DE
Effective URL: https://cloud.email.communityhealthchoice.org/preferences?qs=c18db216b01dc055e06e5fe8efd36cc30921c77067e296c91198b222c050579374ec3a6c2c26a60ba...
Submission: On May 30 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST https://cloud.email.communityhealthchoice.org/preferences
<form action="https://cloud.email.communityhealthchoice.org/preferences" method="POST">
<div class="row formbg">
<div class="col">
<div class="row mt-3 mb-4">
<div class="col">
<label class="h6" for="email">Email:<span class="red"><sup>*</sup></span></label>
<input type="email" class="form-control" id="email" name="Email" value="" required="">
</div>
</div>
<div class="row mb-4">
<div class="col">
<label class="h6" for="fname">First Name:<span class="red"><sup>*</sup></span></label>
<input type="text" class="form-control" id="fname" name="FirstName" value="" required="">
</div>
<div class="col">
<label class="h6" for="lname">Last Name:<span class="red"><sup>*</sup></span></label>
<input type="text" class="form-control" id="lname" name="LastName" value="" required="">
</div>
</div>
<div class="row mb-4">
<div class="col custom-control custom-checkbox custom-checkbox-grey">
<table class="table">
<thead>
<tr>
<th>Communication Preferences</th>
<th>Email</th>
<th>Text</th>
<th>Phone</th>
</tr>
</thead>
<tbody>
<tr>
<td>Alerts</td>
<td>
<div data-toggle="tooltip" data-placement="left" data-delay="{ "show": 300, "hide": 100 }" title=""
data-original-title="Alerts: Information about natural disasters, weather incidents, closures, immediate health-related information">
<input type="checkbox" class="custom-control-input" id="alerts_email" name="alerts_email" value="true"><label class="custom-control-label table-checkbox" for="alerts_email"></label>
</div>
</td>
<td>
<div data-toggle="tooltip" data-placement="right" data-delay="{ "show": 300, "hide": 100 }" title=""
data-original-title="Alerts: Information about natural disasters, weather incidents, closures, immediate health-related information"><input type="checkbox" class="custom-control-input" id="alerts_text" name="alerts_text"
value="true"><label class="custom-control-label table-checkbox" for="alerts_text"></label></div>
</td>
<td>
<div data-toggle="tooltip" data-placement="right" data-delay="{ "show": 300, "hide": 100 }" title=""
data-original-title="Alerts: Information about natural disasters, weather incidents, closures, immediate health-related information"><input type="checkbox" class="custom-control-input" id="alerts_phone" name="alerts_phone"
value="true"><label class="custom-control-label table-checkbox" for="alerts_phone"></label></div>
</td>
</tr>
<tr>
<td>Reminders</td>
<td>
<div data-toggle="tooltip" data-placement="left" data-delay="{ "show": 300, "hide": 100 }" title="" data-original-title="Reminders: Check-up reminders, payment reminders"><input type="checkbox"
class="custom-control-input" id="reminders_email" name="reminders_email" value="true"><label class="custom-control-label table-checkbox" for="reminders_email"></label></div>
</td>
<td>
<div data-toggle="tooltip" data-placement="right" data-delay="{ "show": 300, "hide": 100 }" title="" data-original-title="Reminders: Check-up reminders, payment reminders"><input type="checkbox"
class="custom-control-input" id="reminders_text" name="reminders_text" value="true"><label class="custom-control-label table-checkbox" for="reminders_text"></label></div>
</td>
<td>
<div data-toggle="tooltip" data-placement="right" data-delay="{ "show": 300, "hide": 100 }" title="" data-original-title="Reminders: Check-up reminders, payment reminders"><input type="checkbox"
class="custom-control-input" id="reminders_phone" name="reminders_phone" value="true"><label class="custom-control-label table-checkbox" for="reminders_phone"></label></div>
</td>
</tr>
<tr>
<td>General Information</td>
<td>
<div data-toggle="tooltip" data-placement="left" data-delay="{ "show": 300, "hide": 100 }" title="" data-original-title="General Information: General health and wellness information"><input type="checkbox"
class="custom-control-input" id="information_email" name="information_email" value="true"><label class="custom-control-label table-checkbox" for="information_email"></label></div>
</td>
<td>
<div data-toggle="tooltip" data-placement="right" data-delay="{ "show": 300, "hide": 100 }" title="" data-original-title="General Information: General health and wellness information"><input type="checkbox"
class="custom-control-input" id="information_text" name="information_text" value="true"><label class="custom-control-label table-checkbox" for="information_text"></label></div>
</td>
<td>
<div data-toggle="tooltip" data-placement="right" data-delay="{ "show": 300, "hide": 100 }" title="" data-original-title="General Information: General health and wellness information"><input type="checkbox"
class="custom-control-input" id="information_phone" name="information_phone" value="true"><label class="custom-control-label table-checkbox" for="information_phone"></label></div>
</td>
</tr>
<tr>
<td>Member Events</td>
<td>
<div data-toggle="tooltip" data-placement="left" data-delay="{ "show": 300, "hide": 100 }" title=""
data-original-title="Member Events: Information on events for members such as sporting events or family outings"><input type="checkbox" class="custom-control-input" id="events_email" name="events_email" value="true"><label
class="custom-control-label table-checkbox" for="events_email"></label></div>
</td>
<td>
<div data-toggle="tooltip" data-placement="right" data-delay="{ "show": 300, "hide": 100 }" title=""
data-original-title="Member Events: Information on events for members such as sporting events or family outings"><input type="checkbox" class="custom-control-input" id="events_text" name="events_text" value="true"><label
class="custom-control-label table-checkbox" for="events_text"></label></div>
</td>
<td>
<div data-toggle="tooltip" data-placement="right" data-delay="{ "show": 300, "hide": 100 }" title=""
data-original-title="Member Events: Information on events for members such as sporting events or family outings"><input type="checkbox" class="custom-control-input" id="events_phone" name="events_phone" value="true"><label
class="custom-control-label table-checkbox" for="events_phone"></label></div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="row pt-3 pb-3">
<div class="col">
<div class="custom-control custom-checkbox custom-checkbox-grey">
<input type="checkbox" class="custom-control-input" id="unsub_all" name="unsub_all" value="true">
<label class="custom-control-label" for="unsub_all">
<h5 class="bold">Unsubscribe From All</h5>I no longer wish to receive any future communications.
</label>
</div>
</div>
</div>
</div>
</div>
<div class="row spacer">
</div>
<div class="row mb-4">
<div class="col d-flex justify-content-center">
<input type="hidden" name="isUpdate" value="true">
<input type="hidden" name="JobID" value="530111">
<input type="hidden" name="RecordId" value="003f400001SBHVIAA5">
<input type="hidden" name="AccountId" value="">
<button class="btn btn-primary" type="submit" value="Validate">Submit</button>
</div>
</div>
</form>Text Content
Email:* First Name:* Last Name:* Communication Preferences Email Text Phone Alerts Reminders General Information Member Events UNSUBSCRIBE FROM ALL I no longer wish to receive any future communications. Submit