mediland.me Open in urlscan Pro
162.255.117.148  Public Scan

Form analysis
2 forms found in the DOM

POST

<form method="POST" id="appointment-contact-form" class="appform" novalidate="novalidate">
  <div class="row">
    <div class="large-3 columns">
      <p>
        <input type="text" placeholder="Full Name" name="appname" id="appname">
      </p>
      <p>
        <input type="text" placeholder="Phone Number" name="appphone" id="appphone">
      </p>
    </div>
    <div class="large-3 columns">
      <p>
        <input type="text" placeholder="E-mail Address" name="appemail" id="appemail">
      </p>
      <p>
        <span class="Zebra_DatePicker_Icon_Wrapper" style="display: block; position: relative; float: none; inset: auto;"><input class="datepicker" type="text" placeholder="Appointment Date" name="appdate" id="appdate" readonly="readonly"
            style="position: relative; inset: auto;"><button type="button" class="Zebra_DatePicker_Icon Zebra_DatePicker_Icon_Inside" style="top: 11px; left: 178px;">Pick a date</button></span>
      </p>
    </div>
    <div class="large-3 columns">
      <p>
        <textarea cols="10" rows="15" name="appmessage" id="appmessage" placeholder="Message"></textarea>
      </p>
    </div>
    <div class="large-3 columns">
      <input type="hidden" name="appdetails" id="appdetails" value="info@mediland.me|Thanks for submission. One of our doctors will contact you to confirm the appointment details.">
      <input type="submit" class="blue button radius" name="appsubmit" id="appsubmit" value="Make Appointment">
    </div>
  </div>
</form>

POST #

<form action="#" method="post" id="contactFormWidget">
  <div class="row">
    <div class="small-6 columns"><input type="text" name="wname" id="wname" value="" size="22" placeholder="Name"></div>
    <div class="small-6 columns"><input type="text" name="wemail" id="wemail" value="" size="22" placeholder="Email"></div>
    <div class="small-12 columns"><textarea name="wmessage" id="wmessage" cols="60" rows="10" placeholder="Message"></textarea></div>
    <div class="loading"></div>
    <div><input type="hidden" name="wcontactemail" id="wcontactemail" value="info@mediland.me"></div>
    <div><input type="hidden" value="http://mediland.me" id="wcontactwebsite" name="wcontactwebsite"></div>
    <div><input type="hidden" name="wcontacturl" id="wcontacturl" value="http://mediland.me/wp-content/themes/medico/library/sendmail.php"></div>
    <div class="large-12 columns text-right"><input type="submit" id="wformsend" value="ENviar" class="button" name="wsend"></div>
    <div class="clear"></div>
    <div class="widgeterror"></div>
    <div class="widgetinfo" style="display: none;">Thank you</div>
  </div>
</form>

Text Content

   
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Performance of all tests actually required in Lebanon



Fast and perfect service for patients



Application of external and internal quality programs



Contracts with NSSF, and majority of assurance companies





LATEST NEWS


 * Jun 03, 2013

VITAMIN D





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 * Jun 03, 2013

ALL ABOUT LEAD BLOOD LEVEL





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 * Jul 21, 2017

TUBERCULOSIS





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 * Jul 22, 2017

صحتك٠٠٠ بالماء





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LATEST FROM THE BLOG

 * Breast Cancer October 27, 2017
   
 * صحتك٠٠٠ بالماء July 22, 2017
   

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CONTACT INFO

 * Rue 65, May bldg., Ground floor El-Jnah, Beyrouth, Lebanon
 * 01 841 307
 * info@Mediland.me

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QUICK CONTACT

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© 2017 Mediland, All Rights Reserved.



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