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Submitted URL: http://www.sante.pro/r/oKbeC/ljzSMH
Effective URL: https://www.sante.pro/r/oKbeC/ljzSMH
Submission: On December 26 via manual from CO — Scanned from FR
Effective URL: https://www.sante.pro/r/oKbeC/ljzSMH
Submission: On December 26 via manual from CO — Scanned from FR
Form analysis
1 forms found in the DOMPOST
<form method="post">
<p> Indiquez les <b>4 premières lettres</b><br> du nom de famille <b>du patient</b> : </p>
<div class="login-field auto-jump">
<input type="text" name="nom[]" minlength="1" maxlength="1" size="1" tabindex="1" required="" autofocus="">
<input type="text" name="nom[]" minlength="1" maxlength="1" size="1" tabindex="2" required="">
<input type="text" name="nom[]" minlength="1" maxlength="1" size="1" tabindex="3" required="">
<input type="text" name="nom[]" minlength="1" maxlength="1" size="1" tabindex="4" required="">
</div>
</form>
Text Content
VOTRE RENDEZ-VOUS LUNDI 06/01/2025 À 16H30 DR MÉOLA MANON Indiquez les 4 premières lettres du nom de famille du patient :