app.chartrequest.com
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urlscan Pro
44.213.242.170
Public Scan
Submitted URL: http://url493.chartrequest.com/ls/click?upn=u001.g15gzftorkRrHRgSN2ixi0Nn7Vtwp1Z472uWExDGHAD-2BFSth0OSrWnJigg3OTkdj1pgeVg7h9EJi...
Effective URL: https://app.chartrequest.com/login
Submission: On August 12 via manual from US — Scanned from DE
Effective URL: https://app.chartrequest.com/login
Submission: On August 12 via manual from US — Scanned from DE
Form analysis
1 forms found in the DOMPOST /login
<form class="new_login_form" action="/login" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓"><input type="hidden" name="authenticity_token"
value="Jd2mYYlr/F3NOPxsHpMoB53wA/bVvCFVgszQXHSpLCzIFJombTYDVEx99yjK3u0xd8/f0/VwfwjA+g+Ixe/kJQ==">
<div class="col-sm-12" style="padding: 5px 0">
<label class="email-pwd-filed">Email Address <input type="text" name="login" id="login" value="" placeholder="Required" class="form-control" style="margin-top: 10px" required="required">
</label>
</div>
<div class="col-sm-12" style="padding: 5px 0">
<div class="password-validation-div">
<label class="email-pwd-filed">Password <span id="pswd-valid" style="display: none"><img src="https://assets.chartrequest.com/assets/custom-icons/icon-checkgreen-74ec182742ae6cb236af077a0f954dfe7392ef2484e310bdbda8d9a6ad2d0d90.png"></span>
<input type="password" name="password" id="user_password" class="form-control" page_info="login_page" placeholder="Required" style="margin-top: 10px">
</label>
<div id="pswd_info">
<p class="w600 f15">Password must meet all requirements:</p>
<ul>
<li id="length" class="invalid">Minimum 8 characters</li>
<li id="letter" class="invalid">At least one lowercase letter (a-z)</li>
<li id="capital" class="invalid">At least one capital letter (A-Z)</li>
<li id="number" class="invalid">At least one number (0-9)</li>
<li id="symbol" class="invalid">At least one symbol (!@#$%^&*)</li>
</ul>
</div>
</div>
</div>
<div class="remove-padding login-remember-forgot">
<label style="font-weight: 300"><input type="checkbox" name="remember_me" id="remember_me" value="1" style="margin-right: 5px">Remember Me</label>
<a href="" data-toggle="modal" data-target="#reset-password" class="pull-right">Forgot Password?</a>
<p class="remember-me-warning-msg text-error w600" style="display: none;"><i class="fa fa-info-circle" aria-hidden="true"></i>Enabling Remember Me is not recommended if there are multiple users on this device.</p>
</div>
<div class="recaptcha-container">
<script src="https://www.recaptcha.net/recaptcha/api.js?onload=disableSubmitButton" async="" defer=""></script>
<div data-sitekey="6LcC8xwUAAAAAA-NQc5ghdY21XsWCP72RyqM7tVc" data-callback="onloadCaptchaCallback" class="g-recaptcha " action="userLoginBtn">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-7433uek0q3y0" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
src="https://www.recaptcha.net/recaptcha/api2/anchor?ar=1&k=6LcC8xwUAAAAAA-NQc5ghdY21XsWCP72RyqM7tVc&co=aHR0cHM6Ly9hcHAuY2hhcnRyZXF1ZXN0LmNvbTo0NDM.&hl=de&v=_ZpyzC9NQw3gYt1GHTrnprhx&size=normal&cb=cpk1nstov7l0"></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>
</div>
<noscript>
<div>
<div style="width: 302px; height: 422px; position: relative;">
<div style="width: 302px; height: 422px; position: absolute;">
<iframe src="https://www.recaptcha.net/recaptcha/api.js?onload=disableSubmitButton/fallback?k=6LcC8xwUAAAAAA-NQc5ghdY21XsWCP72RyqM7tVc" name="ReCAPTCHA"
style="width: 302px; height: 422px; border-style: none; border: 0; overflow: hidden;">
</iframe>
</div>
</div>
<div style="width: 300px; height: 60px; border-style: none;
bottom: 12px; left: 25px; margin: 0px; padding: 0px; right: 25px;
background: #f9f9f9; border: 1px solid #c1c1c1; border-radius: 3px;">
<textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid #c1c1c1;
margin: 10px 25px; padding: 0px; resize: none;"> </textarea>
</div>
</div>
</noscript>
<input type="hidden" name="recaptcha_response" id="recaptcha_response">
<script>
function disableSubmitButton() {
document.querySelector(".userLoginBtn").disabled = true;
}
function onloadCaptchaCallback(response) {
if (response) {
document.querySelector(".userLoginBtn").disabled = false;
document.getElementById('recaptcha_response').value = response;
}
}
</script>
</div>
<button name="button" type="submit" class="btn-login btn userLoginBtn"> Log in </button>
</form>
Text Content
About * * About Us * Platform Benefits * Contact Us Support Sign Up Log in to start Requesting Health Information. × You must be signed in to access that page Email Address Password Password must meet all requirements: * Minimum 8 characters * At least one lowercase letter (a-z) * At least one capital letter (A-Z) * At least one number (0-9) * At least one symbol (!@#$%^&*) Remember Me Forgot Password? Enabling Remember Me is not recommended if there are multiple users on this device. Log in Log in with Google Login with SSO or Don’t have an account? Sign up for free Sign up with Google RESET MY PASSWORD Enter your ChartRequest login email below, and we'll send you a reset password link. Send Reset Link Close RESET LINK SENT We just sent an email to Please check your spam folder if you do not receive your reset password after 1 minute. Close × REMINDER SENT! Mail has been sent. Close