www.cipla-sepsis-day.upconnect.co.in Open in urlscan Pro
103.189.196.30  Public Scan

URL: https://www.cipla-sepsis-day.upconnect.co.in/
Submission: On October 18 via api from US — Scanned from US

Form analysis 1 forms found in the DOM

<form _ngcontent-rqu-c20="" novalidate="" autocomplete="off" class="ng-untouched ng-pristine ng-invalid">
  <div _ngcontent-rqu-c20="" class="card mt-2 rounded-sm border-0 mb-5">
    <div _ngcontent-rqu-c20="" class="card-body">
      <div _ngcontent-rqu-c20="" class="form-group"><label _ngcontent-rqu-c20="" for="doctor_name">Doctor Name*</label><input _ngcontent-rqu-c20="" type="text" id="doctor_name" name="doctor_name" required=""
          class="form-control ng-untouched ng-pristine ng-invalid" placeholder="Enter Doctor Name"></div>
      <div _ngcontent-rqu-c20="" class="form-group"><label _ngcontent-rqu-c20="" for="doctor_email">Doctor Email</label><input _ngcontent-rqu-c20="" type="email" id="doctor_email" name="doctor_email"
          class="form-control ng-untouched ng-pristine ng-valid" placeholder="Enter Doctor Email"></div>
      <div _ngcontent-rqu-c20="" class="form-group"><label _ngcontent-rqu-c20="" for="doctor_phone">Doctor Mobile</label><input _ngcontent-rqu-c20="" type="text" id="doctor_phone" name="doctor_phone"
          class="form-control ng-untouched ng-pristine ng-valid" placeholder="Enter Doctor Mobile"></div>
      <div _ngcontent-rqu-c20="" class="form-group"><label _ngcontent-rqu-c20="" for="doctor_city">Doctor City</label><input _ngcontent-rqu-c20="" type="text" id="doctor_city" name="doctor_city" class="form-control ng-untouched ng-pristine ng-valid"
          placeholder="Enter Doctor City"></div>
      <div _ngcontent-rqu-c20="" class="form-group"><label _ngcontent-rqu-c20="" for="formFileSm">Photo</label><input _ngcontent-rqu-c20="" id="formFileSm" type="file" required="required" accept="image/*" class="form-control form-control-sm"><small
          _ngcontent-rqu-c20="" class="text-danger">*Please select a photo from the gallery for the best experience.</small><image-cropper _ngcontent-rqu-c20="" format="jpeg" _nghost-rqu-c9="" style="text-align: center;">
          <div _ngcontent-rqu-c9=""><img _ngcontent-rqu-c9="" class="ngx-ic-source-image ng-star-inserted" src="data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAAC0lEQVQYV2NgAAIAAAUAAarVyFEAAAAASUVORK5CYII="
              style="visibility: visible;"><!---->
            <div _ngcontent-rqu-c9="" class="ngx-ic-overlay" style="width: 0px; height: 0px; margin-left: 0px;"></div>
            <div _ngcontent-rqu-c9="" tabindex="0" class="ngx-ic-cropper ng-star-inserted" style="top: -100px; left: -100px; width: 10100px; height: 10100px; margin-left: 0px; visibility: visible;">
              <div _ngcontent-rqu-c9="" class="ngx-ic-move"></div><span _ngcontent-rqu-c9="" class="ngx-ic-resize ngx-ic-topleft ng-star-inserted"><span _ngcontent-rqu-c9="" class="ngx-ic-square"></span></span><span _ngcontent-rqu-c9=""
                class="ngx-ic-resize ngx-ic-top ng-star-inserted"><span _ngcontent-rqu-c9="" class="ngx-ic-square"></span></span><span _ngcontent-rqu-c9="" class="ngx-ic-resize ngx-ic-topright ng-star-inserted"><span _ngcontent-rqu-c9=""
                  class="ngx-ic-square"></span></span><span _ngcontent-rqu-c9="" class="ngx-ic-resize ngx-ic-right ng-star-inserted"><span _ngcontent-rqu-c9="" class="ngx-ic-square"></span></span><span _ngcontent-rqu-c9=""
                class="ngx-ic-resize ngx-ic-bottomright ng-star-inserted"><span _ngcontent-rqu-c9="" class="ngx-ic-square"></span></span><span _ngcontent-rqu-c9="" class="ngx-ic-resize ngx-ic-bottom ng-star-inserted"><span _ngcontent-rqu-c9=""
                  class="ngx-ic-square"></span></span><span _ngcontent-rqu-c9="" class="ngx-ic-resize ngx-ic-bottomleft ng-star-inserted"><span _ngcontent-rqu-c9="" class="ngx-ic-square"></span></span><span _ngcontent-rqu-c9=""
                class="ngx-ic-resize ngx-ic-left ng-star-inserted"><span _ngcontent-rqu-c9="" class="ngx-ic-square"></span></span><span _ngcontent-rqu-c9="" class="ngx-ic-resize-bar ngx-ic-top ng-star-inserted"></span><span _ngcontent-rqu-c9=""
                class="ngx-ic-resize-bar ngx-ic-right ng-star-inserted"></span><span _ngcontent-rqu-c9="" class="ngx-ic-resize-bar ngx-ic-bottom ng-star-inserted"></span><span _ngcontent-rqu-c9=""
                class="ngx-ic-resize-bar ngx-ic-left ng-star-inserted"></span><!----><!---->
            </div><!---->
          </div>
        </image-cropper></div><!----><!---->
    </div>
    <div _ngcontent-rqu-c20="" class="row">
      <div _ngcontent-rqu-c20="" class="col-12 text-center"><button _ngcontent-rqu-c20="" type="submit" class="btn btn-primary" disabled="">Save </button></div>
    </div>
  </div>
</form>

Text Content

Add Doctor

Doctor Name*
Doctor Email
Doctor Mobile
Doctor City
Photo*Please select a photo from the gallery for the best experience.

Save