link.newsletter.wh.com Open in urlscan Pro
81.92.125.211  Public Scan

Form analysis
1 forms found in the DOM

Name: PageForm — POST /wf/200241/6/5/en/Form0/Submit.act;jsessionid=00249BF040B9283456EF5B13D0FBB244

<form method="post" action="/wf/200241/6/5/en/Form0/Submit.act;jsessionid=00249BF040B9283456EF5B13D0FBB244" name="PageForm" id="contest">
  <div class="input" id="QA_97_question">
    <label for="QA_97_val">First name&nbsp;*</label>
    <input class="" type="text" name="QA_97_val" id="QA_97_val" value="Kristel">
  </div>
  <input type="hidden" name="WFA_IFDKey_97" value="QA_97" id="WFA_IFDKey_97"><input type="hidden" name="QA_97_presentationType" value="textfield" id="QA_97_presentationType">
  <div class="input" id="QA_98_question">
    <label for="QA_98_val">Last name&nbsp;*</label>
    <input class="" type="text" name="QA_98_val" id="QA_98_val" value="Goovaerts">
  </div>
  <input type="hidden" name="WFA_IFDKey_98" value="QA_98" id="WFA_IFDKey_98"><input type="hidden" name="QA_98_presentationType" value="textfield" id="QA_98_presentationType">
  <div class="input" id="QA_99_question">
    <label for="QA_99_val">Email&nbsp;*</label>
    <input class="" type="email" name="QA_99_val" id="QA_99_val" value="info@esthedent.be">
  </div>
  <input type="hidden" name="WFA_IFDKey_99" value="QA_99" id="WFA_IFDKey_99"><input type="hidden" name="QA_99_presentationType" value="textfield" id="QA_99_presentationType">
  <p class="paragraph" id="iq3">I am interested in...</p>
  <div class="radio" id="QA_608_question">
    <h2>Restoration &amp; Prosthetics</h2>
    <div class="custom-radio">
      <input type="radio" name="QA_608" id="QA_608_Y" value="Y">
      <label for="QA_608_Y" id="QA_608_Y_label">Yes</label>
    </div>
    <div class="custom-radio">
      <input type="radio" name="QA_608" id="QA_608_N" value="N">
      <label for="QA_608_N" id="QA_608_N_label">No</label>
    </div>
  </div>
  <input type="hidden" name="WFA_IFDKey_608" value="QA_608" id="WFA_IFDKey_608"><input type="hidden" name="QA_608_presentationType" value="radio" id="QA_608_presentationType">
  <div class="radio" id="QA_609_question">
    <h2>Sterilization, Hygiene &amp; Maintenance</h2>
    <div class="custom-radio">
      <input type="radio" name="QA_609" id="QA_609_Y" value="Y">
      <label for="QA_609_Y" id="QA_609_Y_label">Yes</label>
    </div>
    <div class="custom-radio">
      <input type="radio" name="QA_609" id="QA_609_N" value="N">
      <label for="QA_609_N" id="QA_609_N_label">No</label>
    </div>
  </div>
  <input type="hidden" name="WFA_IFDKey_609" value="QA_609" id="WFA_IFDKey_609"><input type="hidden" name="QA_609_presentationType" value="radio" id="QA_609_presentationType">
  <div class="radio" id="QA_610_question">
    <h2>Oral Surgery &amp; Implantology</h2>
    <div class="custom-radio">
      <input type="radio" name="QA_610" id="QA_610_Y" value="Y">
      <label for="QA_610_Y" id="QA_610_Y_label">Yes</label>
    </div>
    <div class="custom-radio">
      <input type="radio" name="QA_610" id="QA_610_N" value="N">
      <label for="QA_610_N" id="QA_610_N_label">No</label>
    </div>
  </div>
  <input type="hidden" name="WFA_IFDKey_610" value="QA_610" id="WFA_IFDKey_610"><input type="hidden" name="QA_610_presentationType" value="radio" id="QA_610_presentationType">
  <div class="radio" id="QA_611_question">
    <h2>Prophylaxis &amp; Periodontology</h2>
    <div class="custom-radio">
      <input type="radio" name="QA_611" id="QA_611_Y" value="Y">
      <label for="QA_611_Y" id="QA_611_Y_label">Yes</label>
    </div>
    <div class="custom-radio">
      <input type="radio" name="QA_611" id="QA_611_N" value="N">
      <label for="QA_611_N" id="QA_611_N_label">No</label>
    </div>
  </div>
  <input type="hidden" name="WFA_IFDKey_611" value="QA_611" id="WFA_IFDKey_611"><input type="hidden" name="QA_611_presentationType" value="radio" id="QA_611_presentationType">
  <div class="radio" id="QA_612_question">
    <h2>Endodontics</h2>
    <div class="custom-radio">
      <input type="radio" name="QA_612" id="QA_612_Y" value="Y">
      <label for="QA_612_Y" id="QA_612_Y_label">Yes</label>
    </div>
    <div class="custom-radio">
      <input type="radio" name="QA_612" id="QA_612_N" value="N">
      <label for="QA_612_N" id="QA_612_N_label">No</label>
    </div>
  </div>
  <input type="hidden" name="WFA_IFDKey_612" value="QA_612" id="WFA_IFDKey_612"><input type="hidden" name="QA_612_presentationType" value="radio" id="QA_612_presentationType">
  <div class="radio" id="QA_613_question">
    <h2>Dental Laboratory</h2>
    <div class="custom-radio">
      <input type="radio" name="QA_613" id="QA_613_Y" value="Y">
      <label for="QA_613_Y" id="QA_613_Y_label">Yes</label>
    </div>
    <div class="custom-radio">
      <input type="radio" name="QA_613" id="QA_613_N" value="N">
      <label for="QA_613_N" id="QA_613_N_label">No</label>
    </div>
  </div>
  <input type="hidden" name="WFA_IFDKey_613" value="QA_613" id="WFA_IFDKey_613"><input type="hidden" name="QA_613_presentationType" value="radio" id="QA_613_presentationType">
  <p class="mandatory">* Mandatory fields</p>
  <div class="button-container">
    <button type="submit" class="btn btn-next">Submit</button>
  </div>
</form>

Text Content

First name *
Last name *
Email *

I am interested in...


RESTORATION & PROSTHETICS

Yes
No


STERILIZATION, HYGIENE & MAINTENANCE

Yes
No


ORAL SURGERY & IMPLANTOLOGY

Yes
No


PROPHYLAXIS & PERIODONTOLOGY

Yes
No


ENDODONTICS

Yes
No


DENTAL LABORATORY

Yes
No

* Mandatory fields

Submit