ntre.baskerso.buzz Open in urlscan Pro
172.67.197.125  Public Scan

Form analysis
1 forms found in the DOM

POST confirm/index.php

<form id="order-frame" class="registration-form" action="confirm/index.php" method="post">
  <div class="material-field">
    <div class="material-field-has-error" data-validate-for="phone">&nbsp;</div>
    <input class="material-field-input" required="" type="text" value="" placeholder="Введите Имя"> <label class="material-field-label"></label>
  </div>
  <div class="material-field">
    <div class="material-field-has-error" data-validate-for="phone">&nbsp;</div>
    <input class="material-field-input" name="phone" required="" type="tel" value="" placeholder="Введите Телефон">
  </div>
  <div class="material-field">
    <div class="material-field-has-error" data-validate-for="category">&nbsp;</div>
  </div>
  <button class="main-button" type="submit">Записаться</button>
  <div class="text-center mt-2" style="color: red;" data-validate-for="_errors">&nbsp;</div>
</form>

Text Content

Оставить заявку


БЕСПЛАТНАЯ КОНСУЛЬТАЦИЯ ПРИ БОЛЯХ В СУСТАВАХ!

 * Индивидуальный подход к каждому.

 * Профессиональная помощь опытных урологов.

 * Экономия личного времени;

 * Возможность записаться в любое время;
   
   Мы позаботимся о вашем здоровье!


 
 
 
Записаться
 
 

 

 

ООО «Медицина АльфаСтрахования», г. Москва, Комсомольский пр-т, д. 17, ИНН:
7728240723, ОГРН: 1027739432687

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