portal.bewelldata.com Open in urlscan Pro
173.241.229.108  Public Scan

Form analysis
1 forms found in the DOM

POST p-auth.htm

<form id="frm_login" action="p-auth.htm" method="post">
  <!-- Added input-row -->
  <div class="input-row">
    <!-- Added label -->
    <label>Username:</label>
    <!-- Added Tooltip -->
    <input type="text" name="user" value="">
  </div>
  <div style="clear:both"></div>
  <!-- Added input-row -->
  <div class="input-row">
    <!-- Added label -->
    <label>Password:</label>
    <div style="clear:both"></div>
    <input type="password" name="pass" value="">
    <input type="hidden" name="hdnpass" id="hdnpass">
  </div>
  <div style="clear:both"></div>
  <!--<a class="button" href="#" onclick="sendpass();">LOGIN</a>-->
  <input type="submit" class="button" value="LOGIN">
  <!-- Moved Rember me below submit -->
  <br>
  <div class="remember"><input type="checkbox" name="remember">Remember Me</div>
  <br>
  <div style="clear:both"></div>
  <a href="forgotpwd.htm">Forgot Username or Password?</a>
</form>

Text Content

 * Member Login
 * Privacy Policy
 * Help
 * Contact Us

Username:

Password:



Remember Me


Forgot Username or Password?
Be Well Solutions
30625 Solon Rd., Suite C
Cleveland, OH 44139
P: 216-378-0888
F: 440-498-1366
info@bewellsolutions.com

 
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