www.assistancefeedback.com
Open in
urlscan Pro
185.92.121.138
Public Scan
URL:
https://www.assistancefeedback.com/cgi-bin/qwebcorporate.dll?idx=B5SQ9P&l=english_uk&rk=629B5D7&AZP_Survey10A_Claims_MEDI_Q1=1
Submission: On March 09 via manual from AE — Scanned from DE
Submission: On March 09 via manual from AE — Scanned from DE
Form analysis 1 forms found in the DOM
Name: mainForm — POST /cgi-bin/qwebcorporate.dll
<form name="mainForm" id="mainForm" method="POST" action="/cgi-bin/qwebcorporate.dll" onsubmit="return ValidateForm();">
<input type="hidden" name="pageloadcompletedrequired" value="pageloadcompletedrequired">
<input type="hidden" name="useragent" id="useragent"
value="{"ua":"Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/111.0.5563.64 Safari/537.36","browser":{"name":"Chrome","version":"111.0.5563.64","major":"111"},"engine":{"name":"WebKit","version":"537.36"},"os":{"name":"Windows","version":"10"},"device":{},"cpu":{"architecture":"amd64"}}">
<input type="hidden" name="rawuseragent" id="rawuseragent" value="Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/111.0.5563.64 Safari/537.36">
<input type="hidden" name="surveykey" value="INQ-20200725140525-679687263">
<input type="hidden" name="deploymentkey" value="INQ-20230202093506-1249162947">
<input type="hidden" name="id" value="B5SQ9P">
<input type="hidden" name="datfile" value="B5SQ9P.DAT">
<input type="hidden" name="request" value="survey">
<input type="hidden" name="nextpage" value="3">
<input type="hidden" name="currentpage" value="2">
<input type="hidden" name="pageselect" value="0">
<input type="hidden" name="language" value="">
<input type="hidden" name="cultureCode" value="en">
<input type="hidden" id="action" name="action" value="">
<input type="hidden" id="isMobilePreview" name="isMobilePreview" value="0">
<input type="hidden" id="mcx-tag-SubLob" name="mcx-tag-SubLob" value="6">
<input type="hidden" id="mcx-tag-Theme_Platform" name="mcx-tag-Theme_Platform" value="2">
<input type="hidden" id="mcx-tag-CUST_LANG_SEL" name="mcx-tag-CUST_LANG_SEL" value="1">
<input type="hidden" id="mcx-tag-Brand_logo_link" name="mcx-tag-Brand_logo_link" value="16">
<input type="hidden" name="respondent" value="INQ-20230309134844-893971071">
<input type="hidden" name="respondentkey" value="629B5D7">
<input type="hidden" name="idx" value="B5SQ9P">
<input type="hidden" name="visibleobjids" value="">
<input type="hidden" name="decimal_separator" value=".">
<input type="hidden" name="thousands_separator" value=",">
<div id="template" class="lang-index-0">
<!--BANNER_TOP-->
<div id="divValidationMessage" style="display: none;">
<div class="validationError" id="divValidationMessageHeader">
<div class="validationMessageIcon">
<img alt="Attention" id="validationMessageIcon" src="https://www.assistancefeedback.com/surveys/images/error.png">
</div>
<div class="validationMessageText" tabindex="-1" role="alert" aria-labelledby="errorSummaryHeading">
</div>
<div class="validationCloseIcon">
<a href="javascript:void(0);" onclick="closeValidationMessage()">
<img alt="Close" id="validationMessageClose" src="https://www.assistancefeedback.com/surveys/images/close.png" border="0">
</a>
</div>
<div style="clear: both;">
</div>
</div>
<div class="validationMessageShadow" id="divValidationShadow"> </div>
</div>
<div id="survey" class="surveyBackground">
<fieldset>
<legend style="display:none">Claims</legend>
<div class="header" id="header">
<div id="headerLogoContainer">
<img alt="Logo" class="header-logo" id="headerLogoImage" src="https://www.assistancefeedback.com/surveys/images/B5SQ9P/headerlogo.png?ts=20230202093056">
</div>
<div id="headerTextContainer">
<span class="heading1 header-text" id="headerText"></span>
</div>
<div style="clear: both;"></div>
<div id="headerLogo1">
<div class="headerLogo1img"></div>
</div>
<div id="headerLogo2">
<div class="headerLogo2img"></div>
</div>
</div>
<div class="right topNavigation">
<table cellspacing="0" class="navigationContainer" role="presentation">
<tbody>
<tr>
<td>
<div id="progressBarText" style="position:absolute;left:-999em;top:-999em">survey progress 20 percent</div>
<div class="springgreen progressBar">
<ul aria-hidden="true">
<li class="first percentComplete10 done"> </li>
<li class="percentComplete20 done"> </li>
<li class="percentComplete30 ready"> </li>
<li class="percentComplete40 ready"> </li>
<li class="percentComplete50 ready"> </li>
<li class="percentComplete60 ready"> </li>
<li class="percentComplete70 ready"> </li>
<li class="percentComplete80 ready"> </li>
<li class="percentComplete90 ready"> </li>
<li class="last percentComplete100 ready"> </li>
</ul>
</div>
</td>
</tr>
</tbody>
</table>
<div style="clear: both;"></div>
</div>
<div id="canvas">
<h1 class="visuallyHidden"></h1>
<!-- Q00241ED8.Q00241ED9 BEGIN -->
<!-- Question for Q00241ED8.Q00241ED9 -->
<div id="PipeSelector_question" data-handle="Q00241ED8.Q00241ED9" data-auto-answer="1" data-question-tag="PipeSelector" class="question-object object alleg-hide " style="display: none;" role="group"
aria-labelledby="PipeSelector_questionText">
<div class="questionText" id="PipeSelector_questionText">
<div>PipeSelector</div>
</div>
<!-- Start border -->
<table style="width: 90%;" cellspacing="0" class="question" role="presentation">
<tbody>
<tr>
<td>
<table width="100%" cellspacing="0" role="presentation">
<tbody>
<tr class="alt" id="Q00241EDA_answer" style="display: none;" data-display-logic-target="true">
<td data-columnid="3" style="height: 28px; width: 26px;" class="ControlCell">
<div class="iradio_minimal" style="position: relative;"><input type="radio" name="Q00241ED8.Q00241ED9" value="0" id="Q00241ED8_Q00241ED9_A1"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"><ins class="iCheck-helper"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"></ins></div>
</td>
<td data-columnid="4" data-column-type="answer" data-display-sequence="0"><label for="Q00241ED8_Q00241ED9_A1"><span class="answerText">Language:</span></label></td>
</tr>
<tr id="Q00241EDB_answer" style="display: none;" data-display-logic-target="true">
<td data-columnid="3" style="height: 28px; width: 26px;" class="ControlCell">
<div class="iradio_minimal" style="position: relative;"><input type="radio" name="Q00241ED8.Q00241ED9" value="1" id="Q00241ED8_Q00241ED9_A2"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"><ins class="iCheck-helper"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"></ins></div>
</td>
<td data-columnid="4" data-column-type="answer" data-display-sequence="1"><label for="Q00241ED8_Q00241ED9_A2"><span class="answerText">Langue :</span></label></td>
</tr>
<tr class="alt" id="Q00241EDC_answer" style="display: none;" data-display-logic-target="true">
<td data-columnid="3" style="height: 28px; width: 26px;" class="ControlCell">
<div class="iradio_minimal" style="position: relative;"><input type="radio" name="Q00241ED8.Q00241ED9" value="2" id="Q00241ED8_Q00241ED9_A3"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"><ins class="iCheck-helper"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"></ins></div>
</td>
<td data-columnid="4" data-column-type="answer" data-display-sequence="2"><label for="Q00241ED8_Q00241ED9_A3"><span class="answerText">Lingua:</span></label></td>
</tr>
<tr id="Q004AE84D_answer" style="display: none;" data-display-logic-target="true">
<td data-columnid="3" style="height: 28px; width: 26px;" class="ControlCell">
<div class="iradio_minimal" style="position: relative;"><input type="radio" name="Q00241ED8.Q00241ED9" value="3" id="Q00241ED8_Q00241ED9_A4"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"><ins class="iCheck-helper"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"></ins></div>
</td>
<td data-columnid="4" data-column-type="answer" data-display-sequence="3"><label for="Q00241ED8_Q00241ED9_A4"><span class="answerText">Czech Language / Language:</span></label></td>
</tr>
<tr class="alt" id="Q004AE84E_answer" style="display: none;" data-display-logic-target="true">
<td data-columnid="3" style="height: 28px; width: 26px;" class="ControlCell">
<div class="iradio_minimal" style="position: relative;"><input type="radio" name="Q00241ED8.Q00241ED9" value="4" id="Q00241ED8_Q00241ED9_A5"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"><ins class="iCheck-helper"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"></ins></div>
</td>
<td data-columnid="4" data-column-type="answer" data-display-sequence="4"><label for="Q00241ED8_Q00241ED9_A5"><span class="answerText">Slovak Language / Language:</span></label></td>
</tr>
<tr id="Q004AE84F_answer" style="display: none;" data-display-logic-target="true">
<td data-columnid="3" style="height: 28px; width: 26px;" class="ControlCell">
<div class="iradio_minimal" style="position: relative;"><input type="radio" name="Q00241ED8.Q00241ED9" value="5" id="Q00241ED8_Q00241ED9_A6"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"><ins class="iCheck-helper"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"></ins></div>
</td>
<td data-columnid="4" data-column-type="answer" data-display-sequence="5"><label for="Q00241ED8_Q00241ED9_A6"><span class="answerText">Idioma / Language:</span></label></td>
</tr>
<tr class="alt" id="Q004AE850_answer" style="display: none;" data-display-logic-target="true">
<td data-columnid="3" style="height: 28px; width: 26px;" class="ControlCell">
<div class="iradio_minimal" style="position: relative;"><input type="radio" name="Q00241ED8.Q00241ED9" value="6" id="Q00241ED8_Q00241ED9_A7"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"><ins class="iCheck-helper"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"></ins></div>
</td>
<td data-columnid="4" data-column-type="answer" data-display-sequence="6"><label for="Q00241ED8_Q00241ED9_A7"><span class="answerText">Trad. CN Language / Language:</span></label></td>
</tr>
<tr id="Q004AE851_answer" style="display: none;" data-display-logic-target="true">
<td data-columnid="3" style="height: 28px; width: 26px;" class="ControlCell">
<div class="iradio_minimal" style="position: relative;"><input type="radio" name="Q00241ED8.Q00241ED9" value="7" id="Q00241ED8_Q00241ED9_A8"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"><ins class="iCheck-helper"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"></ins></div>
</td>
<td data-columnid="4" data-column-type="answer" data-display-sequence="7"><label for="Q00241ED8_Q00241ED9_A8"><span class="answerText">Simpl. CN Language / Language:</span></label></td>
</tr>
<tr class="alt" id="Q004AE852_answer" style="display: none;" data-display-logic-target="true">
<td data-columnid="3" style="height: 28px; width: 26px;" class="ControlCell">
<div class="iradio_minimal" style="position: relative;"><input type="radio" name="Q00241ED8.Q00241ED9" value="8" id="Q00241ED8_Q00241ED9_A9"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"><ins class="iCheck-helper"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"></ins></div>
</td>
<td data-columnid="4" data-column-type="answer" data-display-sequence="8"><label for="Q00241ED8_Q00241ED9_A9"><span class="answerText">Français / عربي:</span></label></td>
</tr>
<tr id="Q004AE853_answer" data-display-logic-target="true">
<td data-columnid="3" style="height: 28px; width: 26px;" class="ControlCell">
<div class="iradio_minimal checked" style="position: relative;"><input type="radio" name="Q00241ED8.Q00241ED9" value="9" checked="" id="Q00241ED8_Q00241ED9_A10"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"><ins class="iCheck-helper"
style="position: absolute; top: -20%; left: -20%; display: block; width: 140%; height: 140%; margin: 0px; padding: 0px; background: rgb(255, 255, 255); border: 0px; opacity: 0;"></ins></div>
</td>
<td data-columnid="4" data-column-type="answer" data-display-sequence="9"><label for="Q00241ED8_Q00241ED9_A10"><span class="answerText">English / Français / عربي:</span></label></td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
<!-- End border -->
</div> <!-- Q00241ED8.Q00241ED9 -->
<!-- Q00241ED8.Q00241ED9 END -->
<!-- Q00241EE3.Q00241EE4 BEGIN -->
<!-- Question for Q00241EE3.Q00241EE4 -->
<div id="FakeLang_question" data-handle="Q00241EE3.Q00241EE4" data-auto-answer="0" data-question-tag="FakeLang" class="question-object object " style="visibility: visible; display: block;">
<label for="FakeLang">
<div class="questionText">
<div>English / Français / عربي:</div>
</div>
</label>
<select id="FakeLang" name="Q00241EE3.Q00241EE4" class="use-select2 select2-hidden-accessible" data-select2-id="FakeLang" tabindex="-1" aria-hidden="true">
<option value="" data-display-sequence="1" data-parent="FakeLang" class="column-enabled" data-select2-id="2">
</option>
<option id="Q00241EE6_answer" data-display-logic-target="true" value="1" data-display-sequence="3" data-parent="FakeLang" class="column-enabled">Français</option>
<option id="Q004AE860_answer" data-display-logic-target="true" value="4" data-display-sequence="6" data-parent="FakeLang" class="column-enabled">عربي</option>
<option id="Q004AE864_answer" data-display-logic-target="true" value="8" data-display-sequence="10" data-parent="FakeLang" class="column-enabled" selected="selected">English</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="1" style="width: 560px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-FakeLang-container"><span class="select2-selection__rendered" id="select2-FakeLang-container" role="textbox" aria-readonly="true" title="
">
</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> <!-- Q00241EE3.Q00241EE4 -->
<!-- Q00241EE3.Q00241EE4 END -->
<!-- Q00241EEA.Q00241EEB BEGIN -->
<!-- Question for Q00241EEA.Q00241EEB -->
<div id="l_question" data-handle="Q00241EEA.Q00241EEB" data-auto-answer="0" data-question-tag="l" class="question-object object alleg-hide ">
<label for="l">
<div class="questionText">
<div>Please select a language:</div>
</div>
</label>
<input type="hidden" name="languageid" value="Q00241EEA.Q00241EEB">
<select id="l" name="Q00241EEA.Q00241EEB" class="use-select2 select2-hidden-accessible" data-select2-id="l" tabindex="-1" aria-hidden="true">
<option value="0">English</option>
<option value="1">French</option>
<option value="2">Italian</option>
<option value="3">Spanish (Spain)</option>
<option value="4">Arabic</option>
<option value="5">Czech</option>
<option value="6">Chinese (Simplified)</option>
<option value="7">Chinese (Traditional)</option>
<option value="8" selected="" data-select2-id="4">English (UK)</option>
<option value="9">Slovak</option>
<option value="10">English (US)</option>
<option value="11">French (BE)</option>
<option value="12">Flemish</option>
<option value="13">Dutch</option>
<option value="14">German</option>
<option value="15">Croatian</option>
<option value="16">Romanian</option>
<option value="17">Hungarian</option>
<option value="18">Slovenian</option>
<option value="19">Bulgarian</option>
<option value="20">Polish (Poland)</option>
<option value="21">English (GB)</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="3" style="width: auto;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-l-container"><span class="select2-selection__rendered" id="select2-l-container" role="textbox" aria-readonly="true" title="English (UK)">English
(UK)</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> <!-- Q00241EEA.Q00241EEB -->
<!-- Q00241EEA.Q00241EEB END -->
</div> <!-- #canvas -->
<div class="center bottomNavigation">
<table cellspacing="0" class="navigationContainer" role="presentation">
<tbody>
<tr>
<td>
<button class="backButton cleangray" type="button" aria-label="Back">Back</button>
<button class="nextButton cleangray" type="button" aria-label="Next">Next</button>
</td>
</tr>
</tbody>
</table>
<div style="clear: both;"></div>
</div>
</fieldset>
</div> <!-- #survey -->
</div> <!-- #template -->
<input type="hidden" name="pageloadcompleted" value="pageloadcompleted">
</form>Text Content
Claims survey progress 20 percent * * * * * * * * * * PipeSelector Language: Langue : Lingua: Czech Language / Language: Slovak Language / Language: Idioma / Language: Trad. CN Language / Language: Simpl. CN Language / Language: Français / عربي: English / Français / عربي: English / Français / عربي: Français عربي English Please select a language: English French Italian Spanish (Spain) Arabic Czech Chinese (Simplified) Chinese (Traditional) English (UK) Slovak English (US) French (BE) Flemish Dutch German Croatian Romanian Hungarian Slovenian Bulgarian Polish (Poland) English (GB) English (UK) Back Next EnglishItalianoEspañolCzech (Language name)Chinese Simpl. (Language name)Chinese Trad. (Language name)Slovak (Language name)