hospital.geniusinfo.tech Open in urlscan Pro
2a02:4780:11:1428:0:3086:878e:2  Public Scan

Form analysis
1 forms found in the DOM

POST https://hospital.geniusinfo.tech/login

<form action="https://hospital.geniusinfo.tech/login" id="loginForm" novalidate="" method="post" accept-charset="utf-8">
  <input type="hidden" name="csrf_stream_token" value="57f5039322b0b850740b18197f92bf63">
  <div class="form-group">
    <label class="control-label" for="email">Email Address</label>
    <input type="text" placeholder="Email Address" name="email" id="email" class="form-control">
  </div>
  <div class="form-group">
    <label class="control-label" for="password">Password</label>
    <input type="password" placeholder="Password" name="password" id="password" class="form-control">
  </div>
  <div class="form-group">
    <label class="control-label" for="user_role">User Role</label>
    <select name="user_role" class="form-control" id="user_role">
      <option value="" selected="selected">Select User Role</option>
      <option value="1">Admin</option>
      <option value="2">Doctor</option>
      <option value="3">Accountant</option>
      <option value="4">Laboratorist</option>
      <option value="5">Nurse</option>
      <option value="6">Pharmacist</option>
      <option value="7">Receptionist</option>
      <option value="8">Representative</option>
      <option value="9">Case Manager</option>
      <option value="10">Patient</option>
    </select>
  </div>
  <div>
    <button type="submit" class="btn btn-success">Log In</button>
  </div>
</form>

Text Content

HOSPITAL LIMITED

Please Log In



Email Address
Password
User Role Select User Role Admin Doctor Accountant Laboratorist Nurse Pharmacist
Receptionist Representative Case Manager Patient
Log In