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Form analysis
2 forms found in the DOM

POST /create-contact.php

<form id="contact-form" class="contact__form" method="post" action="/create-contact.php">
  <div class="row">
    <div class="col-6" data-wow-delay="0.3s">
      <input type="text" id="name" name="name" class="form-control" placeholder="Full name">
    </div>
    <div class="col-6" data-wow-delay="0.3s">
      <input type="email" id="email" name="email" class="form-control" placeholder="Email address">
    </div>
    <div class="col-6" data-wow-delay="0.3s">
      <input type="text" id="dob" name="dob" class="form-control" placeholder="Your Date of Birth">
    </div>
    <div class="col-6" data-wow-delay="0.3s">
      <input type="text" id="phone" name="phone_number" class="form-control" placeholder="Phone number">
    </div>
    <div class="col-6" data-wow-delay="0.3s">
      <input type="text" id="state" name="state" class="form-control" placeholder="Your State">
    </div>
    <div class="col-6" data-wow-delay="0.3s">
      <input type="text" id="city" name="city" class="form-control" placeholder="Your City">
    </div>
    <div class="col-12" data-wow-delay="0.3s">
      <textarea id="street" name="street" class="form-control" rows="5" placeholder="Your street"></textarea>
    </div>
    <input type="checkbox" name="agreement" value="1" style="height: 18px;width: 18px;margin: 4px 0px 0px 15px;">
    <div style="margin: -27px 50px 16px"> I agree , By submitting my cell phone number to receive automated sms/mms messages with more information or quote from Health Complete Advisory. Message frequency may vary. Reply STOP to cancel, Reply HELP
      for contact information. message and date rates may apply <a href="terms-conditions.html">Terms &amp; Conditions</a> | <a href="privacy-policy.html">Privacy Policy</a>
    </div>
    <div class="col-12 text-center" data-wow-delay="0.3s">
      <button class="btn btn-primary py-3" type="submit" style="color: black;background-color: #009eff;">Send</button>
    </div>
  </div>
</form>

POST /opt-contact.php

<form method="POST" action="/opt-contact.php">
  <div class="modal-body"><input type="text" class="form-control" placeholder="Phone" name="ph" required="">
  </div>
  <div class="modal-footer">
    <button type="button" class="btn-temp btn-secondary closeModalButton">Close</button>
    <button type="submit" class="btn-temp btn-primary">Submit</button>
  </div>
</form>

Text Content

Health Complete Advisory
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 * HEALTH COMPLETE ADVISORY


DAVID OSORIO

Here to find your solutions to your health care needs. Reach out for health
coverage options.


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LET US HELP YOU NAVIGATE THE COMPLEX WORLD OF HEALTHCARE COVERAGE OPTIONS AND
FIND THE BEST SOLUTION FOR YOU.


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THROUGH THE PROCESS AND GET YOU THE COVERAGE YOU DESERVE.


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