ref.healthcaresource.com Open in urlscan Pro
64.74.110.196  Public Scan

Form analysis
1 forms found in the DOM

POST /user/respondReference?code=677f9de8280c3dd2693cc1ff8bb5fc8f6f21895e

<form action="/user/respondReference?code=677f9de8280c3dd2693cc1ff8bb5fc8f6f21895e" method="post">
  <div style="text-align: left; margin-bottom: 10px">
    <label>&nbsp;</label>
    <div class="input ">
      <input type="checkbox" value="1" name="agree" id="agree"> I agree to the <a target="_blank" href="/site/terms/role/Reference">Terms and Conditions</a>
    </div>
  </div>
  <div class="actions centered">
    <input class="btn special large" disabled="disabled" type="submit" name="yt1" value="Continue >>>">
  </div>
</form>

Text Content

WELCOME!

This invitation was created for Mr. Herb Scheer.

You have been invited to complete a reference on behalf of Mark Whiteley. Please
accept the terms and conditions below and follow the steps on each page. Mark
has agreed to a release of liability to protect any information you provide.


Click here to view and download the release if desired.

 
I agree to the Terms and Conditions


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