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1 forms found in the DOM

POST /create-contact.php

<form method="post" action="/create-contact.php" id="contact-form">
  <div class="row">
    <div class="col-12 text-center">
      <h2 class="section-title">Let's Connect</h2>
    </div>
    <div class="col-lg-8 mx-auto">
      <div class="bg-white rounded text-center p-5 shadow-down row">
        <h4 class="mb-80">Contact Form</h4>
        <div class="col-md-6">
          <input type="text" id="name" name="name" placeholder="Full name" class="form-control px-0 mb-4" required="">
        </div>
        <div class="col-md-6">
          <input type="email" id="email" name="email" placeholder="Email address" class="form-control px-0 mb-4" required="">
        </div>
        <div class="col-md-6">
          <input type="text" id="city" name="city" placeholder="Your City" class="form-control px-0 mb-4" required="">
        </div>
        <div class="col-md-6">
          <input type="text" id="state" name="state" placeholder="Your State" class="form-control px-0 mb-4" required="">
        </div>
        <div class="col-md-6">
          <input type="text" id="dob" name="dob" placeholder="Your Date of Birth" class="form-control px-0 mb-4" required="">
        </div>
        <div class="col-md-6">
          <input type="phone" id="phone_number" name="phone_number" placeholder="Phone number" class="form-control px-0 mb-4" required="">
        </div>
        <div class="col-12">
          <input type="text" id="street" name="street" placeholder="Your street" class="form-control px-0 mb-4" required="">
        </div>
        <div class="col-lg-6 col-10 mx-auto">
          <button type="submit" class="btn btn-primary w-100">send</button>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

LIRON HEALTH ADVISORY
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HI! I’M
LIRON NITZACHON












I'm a Licensed Private Health Insurance Agent that is helping individuals and
families get the best affordable healthcare plan option available for them to
take advantage of. I navigate all nationwide plans and guide them to the right
choice.


PROFESSIONAL SERVICES

PERSONALIZED HEALTH INSURANCE PLANS

Let us help you find the perfect health insurance plan for you and your family.
Our licensed agents will guide you through all nationwide options to ensure you
get the best coverage at an affordable price.

EXPERT CONSULTATIONS

Our team of experienced health insurance advisors will provide personalized
consultations to help you understand your options and make informed decisions
about your healthcare.

AFFORDABLE HEALTHCARE SOLUTIONS

At LIRON HEALTH ADVISORY, we specialize in finding affordable healthcare
solutions for individuals and families. Let us help you navigate the complex
world of insurance and find a plan that works for your budget.


LET'S CONNECT

CONTACT FORM








send

EMAIL

lnitzachon@gmail.com

PHONE

+18632490660

Copyright © 2024 — LIRON HEALTH ADVISORY