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easternhosp-portal.tcihealth.com.au Open in urlscan Pro
13.237.247.38  Public Scan

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URL: https://easternhosp-portal.tcihealth.com.au/
Submission: On November 08 via api from US — Scanned from AU

Form analysis 1 forms found in the DOM

<form class="flex flex-col w-full items-center gap-y-8">
  <div class="flex flex-col w-full gap-y-2 lg:min-w-[500px]">
    <p class="required svelte-1ytoxez">Please enter your last name</p> <input type="text" placeholder="Your last name" id="lastNameInput" class="input input-sm input-bordered shadow-md">
    <p class="opacity-70 text-sm">If you do not have a last name, enter your first name instead.</p>
  </div>
  <div class="flex flex-col w-full gap-y-2 lg:min-w-[500px]">
    <p class="required svelte-1ytoxez">Date of birth</p>
    <div class="flex w-full shadow-md">
      <div class="flex flex-1 w-full no-transform">
        <div class="date-time-field border border-1 px-1 input-bordered svelte-r9774y w-full" id="8c88f119-4069-4deb-9e28-3181b4acff8d"><span class="relative flex flex-row gap-x-0 flex-1 items-center bg-white p-1  svelte-r9774y" tabindex="0"><input
              type="text" class="76a1ae72-8c10-4c8e-924c-b5627e66f3d7 text-primary  w-[23px] svelte-r9774y" maxlength="2"><span>/</span><input type="text" class="76a1ae72-8c10-4c8e-924c-b5627e66f3d7 text-primary  w-[23px] svelte-r9774y"
              maxlength="2"><span>/</span><input type="text" class="76a1ae72-8c10-4c8e-924c-b5627e66f3d7 text-primary  w-[43px] svelte-r9774y" maxlength="4"> </span> </div>
      </div>
    </div>
  </div> <input class="btn btn-secondary w-full lg:min-w-[500px]  svelte-1ytoxez" type="submit" value="Submit">
</form>

Text Content

www.anaemate.com.au

ABN: 18 656 230 278

TCI Health Pty Ltd

Please enter your last name

If you do not have a last name, enter your first name instead.

Date of birth

//


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