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aizamd-dev-customer-signup.neurocare.ai Open in urlscan Pro
3.131.101.108  Public Scan

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URL: https://aizamd-dev-customer-signup.neurocare.ai/
Submission: On March 14 via automatic, source certstream-suspicious — Scanned from DE

Form analysis 1 forms found in the DOM

<form class="main-content">
  <div class="MuiGrid-root MuiGrid-container create-account-form-wrapper mui-1d3bbye">
    <div class="MuiGrid-root MuiGrid-item MuiGrid-grid-xs-12 MuiGrid-grid-md-6 p-16 mui-m860y2">
      <div style="max-width: 700px; padding: 0px 10px;">
        <p class="MuiTypography-root MuiTypography-body1 mui-1dcsehg">CREATE ACCOUNT</p>
        <div class="mb-10">
          <h3 class="MuiTypography-root MuiTypography-h3 mui-1e7n7a1">Provide us information to create your account</h3>
        </div>
        <div class="mb-5"><label for="firstName">First Name</label>
          <div class="MuiFormControl-root MuiFormControl-fullWidth MuiTextField-root mui-rmvh34">
            <div class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl mui-1foa2f4"><input aria-invalid="false" id=":r1:" placeholder="John"
                class="MuiInputBase-input MuiOutlinedInput-input mui-1x5jdmq" type="text" value="" name="firstName">
              <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline mui-igs3ac">
                <legend class="mui-ihdtdm"><span class="notranslate">​</span></legend>
              </fieldset>
            </div>
          </div>
        </div>
        <div class="mb-5"><label for="lastName">Last Name</label>
          <div class="MuiFormControl-root MuiFormControl-fullWidth MuiTextField-root mui-rmvh34">
            <div class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl mui-1foa2f4"><input aria-invalid="false" id=":r2:" placeholder="Doe"
                class="MuiInputBase-input MuiOutlinedInput-input mui-1x5jdmq" type="text" value="" name="lastName">
              <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline mui-igs3ac">
                <legend class="mui-ihdtdm"><span class="notranslate">​</span></legend>
              </fieldset>
            </div>
          </div>
        </div>
        <div class="mb-5"><label for="email">Email</label>
          <div class="MuiFormControl-root MuiFormControl-fullWidth MuiTextField-root mui-rmvh34">
            <div class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl mui-1foa2f4"><input aria-invalid="false" id=":r3:" placeholder="example@example.com"
                class="MuiInputBase-input MuiOutlinedInput-input mui-1x5jdmq" type="text" value="" name="email">
              <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline mui-igs3ac">
                <legend class="mui-ihdtdm"><span class="notranslate">​</span></legend>
              </fieldset>
            </div>
          </div>
        </div>
        <div class="mb-5"><label for="password">Password</label>
          <div class="MuiFormControl-root MuiFormControl-fullWidth MuiTextField-root mui-rmvh34">
            <div class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl MuiInputBase-adornedEnd mui-17m6e70"><input aria-invalid="false" id=":r4:" placeholder="******"
                class="MuiInputBase-input MuiOutlinedInput-input MuiInputBase-inputAdornedEnd mui-1uvydh2" type="password" value="" name="password"><button
                class="MuiButtonBase-root MuiIconButton-root MuiIconButton-edgeEnd MuiIconButton-sizeMedium mui-1cqmbu3" tabindex="0" type="button"><svg class="MuiSvgIcon-root MuiSvgIcon-fontSizeMedium mui-vubbuv" focusable="false" aria-hidden="true"
                  viewBox="0 0 24 24" data-testid="VisibilityIcon">
                  <path d="M12 4.5C7 4.5 2.73 7.61 1 12c1.73 4.39 6 7.5 11 7.5s9.27-3.11 11-7.5c-1.73-4.39-6-7.5-11-7.5M12 17c-2.76 0-5-2.24-5-5s2.24-5 5-5 5 2.24 5 5-2.24 5-5 5m0-8c-1.66 0-3 1.34-3 3s1.34 3 3 3 3-1.34 3-3-1.34-3-3-3"></path>
                </svg><span class="MuiTouchRipple-root mui-w0pj6f"></span></button>
              <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline mui-igs3ac">
                <legend class="mui-ihdtdm"><span class="notranslate">​</span></legend>
              </fieldset>
            </div>
          </div>
        </div>
        <div class="mb-5"><label for="phoneNumber">Phone Number</label>
          <div class="MuiFormControl-root MuiFormControl-fullWidth MuiTextField-root MuiTelInput-TextField mui-rmvh34">
            <div class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl MuiInputBase-adornedStart mui-1xhz1ss">
              <div class="MuiInputAdornment-root MuiInputAdornment-positionStart MuiInputAdornment-outlined MuiInputAdornment-sizeMedium mui-pdj2ia"><span class="notranslate">​</span><button
                  class="MuiButtonBase-root MuiIconButton-root MuiIconButton-sizeMedium MuiTelInput-IconButton mui-q88s94" tabindex="0" type="button" aria-label="Select country" aria-haspopup="listbox" aria-expanded="false"><span
                    class="MuiTelInput-Flag mui-70qvj9"><img
                      src="data:image/png;base64,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"
                      loading="lazy" width="26" alt="unknown" class="MuiTelInput-FlagImg"></span><span class="MuiTouchRipple-root mui-w0pj6f"></span></button></div><input aria-invalid="false" id=":r5:" placeholder="+** *** ******"
                class="MuiInputBase-input MuiOutlinedInput-input MuiInputBase-inputAdornedStart mui-1ixds2g" type="tel" value="" name="phoneNumber">
              <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline mui-igs3ac">
                <legend class="mui-ihdtdm"><span class="notranslate">​</span></legend>
              </fieldset>
            </div>
          </div>
        </div>
        <div class="mb-5"><label for="country">Country</label>
          <div class="MuiAutocomplete-root MuiAutocomplete-hasPopupIcon mui-18nc3u2">
            <div class="MuiFormControl-root MuiFormControl-fullWidth MuiTextField-root mui-rmvh34">
              <div class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl MuiInputBase-adornedEnd MuiAutocomplete-inputRoot mui-17m6e70"><input aria-invalid="false" autocomplete="off"
                  id=":r6:" placeholder="Name" class="MuiInputBase-input MuiOutlinedInput-input MuiInputBase-inputAdornedEnd MuiAutocomplete-input MuiAutocomplete-inputFocused mui-1uvydh2" aria-autocomplete="list" aria-expanded="false"
                  autocapitalize="none" spellcheck="false" role="combobox" type="text" value="" name="country">
                <div class="MuiAutocomplete-endAdornment mui-mxlkbn"><button class="MuiButtonBase-root MuiIconButton-root MuiIconButton-sizeMedium MuiAutocomplete-popupIndicator mui-uge3vf" tabindex="-1" type="button" aria-label="Open"
                    title="Open"><svg class="MuiSvgIcon-root MuiSvgIcon-fontSizeMedium mui-vubbuv" focusable="false" aria-hidden="true" viewBox="0 0 24 24" data-testid="ArrowDropDownIcon">
                      <path d="M7 10l5 5 5-5z"></path>
                    </svg><span class="MuiTouchRipple-root mui-w0pj6f"></span></button></div>
                <fieldset aria-hidden="true" class="MuiOutlinedInput-notchedOutline mui-igs3ac">
                  <legend class="mui-ihdtdm"><span class="notranslate">​</span></legend>
                </fieldset>
              </div>
            </div>
          </div>
        </div>
        <div class="mb-16"><label for="referralCode">ReferralCode</label>
          <div class="MuiFormControl-root MuiFormControl-fullWidth MuiTextField-root mui-rmvh34">
            <div class="MuiInputBase-root MuiOutlinedInput-root MuiInputBase-colorPrimary MuiInputBase-fullWidth MuiInputBase-formControl MuiInputBase-adornedEnd mui-17m6e70"><input aria-invalid="false" id=":r8:" placeholder=""
                class="MuiInputBase-input MuiOutlinedInput-input MuiInputBase-inputAdornedEnd mui-1uvydh2" type="text" name="referralCode"><button
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