slingeland-infectiepreventie.hicapp.nl Open in urlscan Pro
185.89.7.89  Public Scan

Form analysis
1 forms found in the DOM

Name: kformname0 — POST

<form method="post" name="kformname0" action="" accept-charset="utf-8"> <input type="text" name="k_user_name" id="k_user_name" value="" class="form-control" placeholder="E-mail" style="display:none">
  <div class="col-xs-6">
    <input type="text" name="user_name" id="user_name" value="" class="form-control" placeholder="E-mail">
    <div class="placeholder">
      <span class="input-placeholder">E-mail</span>
    </div>
  </div>
  <div class="col-xs-6">
    <select name="domain" id="domain" class="form-control" placeholder="Organisatie">
      <option value="@">@</option>
    </select>
    <div class="placeholder">
      <span class="input-placeholder">Organisatie</span>
    </div>
  </div>
  <input type="password" name="k_user_pwd" id="k_user_pwd" value="" class="form-control" placeholder="Wachtwoord">
  <div class="placeholder">
    <span class="input-placeholder">Wachtwoord</span><i toggle="#k_user_pwd" class="oog"><i class="pull-right icon-1 demo-icon"></i><i class="pull-right icon-2 demo-icon"></i></i>
  </div>
  <a href="https://slingeland-infectiepreventie.hicapp.nl/users/register.php" class="pull-left register button">Registreren</a>
  <input class="button pull-right" type="submit" value="Inloggen" name="submit">
  <input type="hidden" name="k_hid_kformname0" id="k_hid_kformname0" value="kformname0">
</form>

Text Content

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WELKOM TERUG

E-mail
@
Organisatie
Wachtwoord
Registreren
Wachtwoord vergeten