pureoriginaesthetics.myaestheticrecord.com Open in urlscan Pro
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Form analysis
1 forms found in the DOM

POST https://pureoriginaesthetics.myaestheticrecord.com/login

<form id="login" role="form" method="POST" action="https://pureoriginaesthetics.myaestheticrecord.com/login" novalidate="novalidate">
  <input type="hidden" name="_token" value="EfbPDKznXwsrOW5BY00olbrOiiaWhAoLV0v942oq">
  <div class="field-outer ">
    <div class="field-label">EMAIL</div>
    <div class="input-outer">
      <input id="email" type="email" class="popup-input-box" name="email" value="" placeholder="Enter Your Email">
    </div>
  </div>
  <div class="field-outer ">
    <div class="field-label">Password</div>
    <div class="input-outer">
      <input id="password" type="password" class="popup-input-box login-pswd" placeholder="Enter Your Password" name="password">
    </div>
    <a href="https://pureoriginaesthetics.myaestheticrecord.com/password/reset" class="forgot-pswd">Forgot Password?</a>
  </div>
  <div class="col-sm-12 rahultest">
    <div class="field-outer">
      <div class="g-recaptcha custom-recaptcha" data-callback="imNotARobot" data-sitekey="6Lf418QUAAAAANw7ttjCtTQIs4ujzjJdghQpB705" data-expired-callback="recaptchaExpired">
        <div style="width: 304px; height: 78px;">
          <div><iframe title="reCAPTCHA"
              src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6Lf418QUAAAAANw7ttjCtTQIs4ujzjJdghQpB705&amp;co=aHR0cHM6Ly9wdXJlb3JpZ2luYWVzdGhldGljcy5teWFlc3RoZXRpY3JlY29yZC5jb206NDQz&amp;hl=de&amp;v=CDFvp7CXAHw7k3HxO47Gm1O9&amp;size=normal&amp;cb=b4192u2b20a0"
              width="304" height="78" role="presentation" name="a-jjzsozpbwkj" frameborder="0" scrolling="no"
              sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
            class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
        </div><iframe style="display: none;"></iframe>
      </div>
      <span id="captcha" style="margin-left:1px;color:#2086C8;font-size:13px;min-height:30px;display:block;position: absolute; top: 80px;"></span>
    </div>
  </div>
  <button type="submit" class="blue-button full-width m-t-50">Sign in</button>
  <p>Don’t have an account? <a href="https://pureoriginaesthetics.myaestheticrecord.com/patient/register" class="blue-button full-width m-t-10 not-register">Sign up</a></p>
</form>

Text Content

PURE ORIGIN AESTHETICS


WELCOME TO OUR PATIENT PORTAL

If you are an Existing Patient, please sign in below. If you are new to our
practice, please complete the New Patient Registration to activate your Patient
Portal.
EMAIL

Password

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