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nexus-bpo.com Open in urlscan Pro
2a02:4780:b:858:0:1836:b1b9:10  Public Scan

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URL: https://nexus-bpo.com/
Submission: On July 08 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST /#wpcf7-f88-p22-o1

<form action="/#wpcf7-f88-p22-o1" method="post" class="wpcf7-form init" aria-label="Contact form" novalidate="novalidate" data-status="init">
  <div style="display: none;">
    <input type="hidden" name="_wpcf7" value="88">
    <input type="hidden" name="_wpcf7_version" value="5.7.7">
    <input type="hidden" name="_wpcf7_locale" value="en_US">
    <input type="hidden" name="_wpcf7_unit_tag" value="wpcf7-f88-p22-o1">
    <input type="hidden" name="_wpcf7_container_post" value="22">
    <input type="hidden" name="_wpcf7_posted_data_hash" value="">
  </div>
  <div class="column-12">
    <div class="column-6">
      <p><label>First Name<br>
          <span class="wpcf7-form-control-wrap" data-name="first-name"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="First Name" value="" type="text" name="first-name"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Last Name<br>
          <span class="wpcf7-form-control-wrap" data-name="last-name"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Last Name" value="" type="text" name="last-name"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Date Of Birth<br>
          <span class="wpcf7-form-control-wrap" data-name="dob"><input class="wpcf7-form-control wpcf7-date wpcf7-validates-as-date" aria-invalid="false" placeholder="Date of Birth" value="" type="date" name="dob"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Gender<br>
          <span class="wpcf7-form-control-wrap" data-name="gender"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="M" value="" type="text" name="gender"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Phone<br>
          <span class="wpcf7-form-control-wrap" data-name="phone"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="305199932" value="" type="text" name="phone"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Email<br>
          <span class="wpcf7-form-control-wrap" data-name="email"><input size="40" class="wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-email" aria-invalid="false" placeholder="luis@lapiera.com" value="" type="email"
              name="email"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Address 1<br>
          <span class="wpcf7-form-control-wrap" data-name="address1"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="12401 Orange Drive" value="" type="text" name="address1"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Address 2<br>
          <span class="wpcf7-form-control-wrap" data-name="address2"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="12401 Orange Drive" value="" type="text" name="address2"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>ZIP Code<br>
          <span class="wpcf7-form-control-wrap" data-name="zipcode"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="33330" value="" type="text" name="zipcode"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>State<br>
          <span class="wpcf7-form-control-wrap" data-name="state"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="FL" value="" type="text" name="state"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>City<br>
          <span class="wpcf7-form-control-wrap" data-name="city"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Davie" value="" type="text" name="city"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Product(s) To Disscuss</label><br>
        <span class="wpcf7-form-control-wrap" data-name="products"><span class="wpcf7-form-control wpcf7-checkbox"><span class="wpcf7-list-item first"><input type="checkbox" name="products[]" value="Back brace"><span
                class="wpcf7-list-item-label">Back brace</span></span><span class="wpcf7-list-item"><input type="checkbox" name="products[]" value="Knee brace"><span class="wpcf7-list-item-label">Knee brace</span></span><span
              class="wpcf7-list-item"><input type="checkbox" name="products[]" value="Wrist brace"><span class="wpcf7-list-item-label">Wrist brace</span></span><span class="wpcf7-list-item"><input type="checkbox" name="products[]"
                value="Ankle brace"><span class="wpcf7-list-item-label">Ankle brace</span></span><span class="wpcf7-list-item"><input type="checkbox" name="products[]" value="Hip brace"><span class="wpcf7-list-item-label">Hip brace</span></span><span
              class="wpcf7-list-item last"><input type="checkbox" name="products[]" value="Elbow brace"><span class="wpcf7-list-item-label">Elbow brace</span></span></span></span>
      </p>
    </div>
    <p><label>Meeting Summary</label>
    </p>
    <div class="column-6">
      <p><label>Initial Method of Contact<br>
          <span class="wpcf7-form-control-wrap" data-name="method"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Phone" value="" type="text" name="method"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Plans<br>
          <span class="wpcf7-form-control-wrap" data-name="plans"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Plans" value="" type="text" name="plans"></span></label>
      </p>
    </div>
    <p><label>Agent, if the form was signed by the beneficiary at time of appointment, provide explanation why SOA was not documented prior to the meeting</label>
    </p>
    <p><label>Beneficiary Agreement</label>
    </p>
    <div class="column-6">
      <p><label>Meeting Date<br>
          <span class="wpcf7-form-control-wrap" data-name="meeting-date"><input class="wpcf7-form-control wpcf7-date wpcf7-validates-as-date" aria-invalid="false" placeholder="02/15/2022" value="" type="date" name="meeting-date"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Meeting Time<br>
          <span class="wpcf7-form-control-wrap" data-name="meeting-time"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="06:20 PM" value="" type="text" name="meeting-time"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Meeting Type<br>
          <span class="wpcf7-form-control-wrap" data-name="meeting-type"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Meeting Telephonic" value="" type="text" name="meeting-type"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Created Date<br>
          <span class="wpcf7-form-control-wrap" data-name="created-date"><input class="wpcf7-form-control wpcf7-date wpcf7-validates-as-date" aria-invalid="false" placeholder="02/15/2022" value="" type="date" name="created-date"></span></label>
      </p>
    </div>
    <p><label>Beneficiary or Authorized Representative Signature and Signature Date</label>
    </p>
    <div class="column-6">
      <p><label>Beneficiary Name<br>
          <span class="wpcf7-form-control-wrap" data-name="beneficiary-name"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Luis Lapeira" value="" type="text" name="beneficiary-name"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Beneficiary Signature Date<br>
          <span class="wpcf7-form-control-wrap" data-name="created-date"><input class="wpcf7-form-control wpcf7-date wpcf7-validates-as-date" aria-invalid="false" placeholder="02/15/2022" value="" type="date" name="created-date"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Representative's Name<br>
          <span class="wpcf7-form-control-wrap" data-name="representative-name"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Luis Lapeira" value="" type="text" name="representative-name"></span></label>
      </p>
    </div>
    <div class="column-6">
      <p><label>Relationship to Beneficiary<br>
          <span class="wpcf7-form-control-wrap" data-name="beneficiary-name"><input size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Luis Lapeira" value="" type="text" name="beneficiary-name"></span></label>
      </p>
    </div>
  </div>
  <p><span class="wpcf7-form-control-wrap" data-name="universal_leadid"><input size="40" class="wpcf7-form-control wpcf7-text" id="leadid_token" aria-invalid="false" value="" type="text" name="universal_leadid"></span>
  </p>
  <p><input class="wpcf7-form-control has-spinner wpcf7-submit" type="submit" value="Submit"><span class="wpcf7-spinner"></span>
  </p>
  <div class="wpcf7-response-output" aria-hidden="true"></div>
  <input type="hidden" name="xxTrustedFormToken" id="xxTrustedFormToken_0" value="https://cert.trustedform.com/1b1184522f0dab2b1023303562e3719a5276567d"><input type="hidden" name="xxTrustedFormCertUrl" id="xxTrustedFormCertUrl_0"
    value="https://cert.trustedform.com/1b1184522f0dab2b1023303562e3719a5276567d"><input type="hidden" name="xxTrustedFormPingUrl" id="xxTrustedFormPingUrl_0"
    value="https://ping.trustedform.com/0.62TCiE2aZzmTyOfNF3YVw4YFf0D3SvX87qkTNgjGg3RBhCCfpdJFMiui0kjFjgScYBs_Q0YI.BBD7bjh3ze4gJ17NRTMnpQ.NKngh8EgvbnwZbjl1yQjVA">
</form>

Text Content

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 * info@nexus-bpo.com


NEXUS BPO

Submit Request

Nexus Bpo is offering a variety of orthopedic related bracing which are made of
high quality products and keeping customers comfort in mind. These Orthopedic
braces comes very handy with your rehab or recoveries and do provide an extra
support in doing activities. If you’ve any questions or interested in buying any
of below available items, do fill out the form at the bottom of the page.


AVAILABLE ITEMS




BACK BRACE

request now


KNEE BRACE

request now


WRIST BRACE

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HIP BRACE

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FREE ESTIMATION


REQUEST A QUOTE

First Name


Last Name


Date Of Birth


Gender


Phone


Email


Address 1


Address 2


ZIP Code


State


City


Product(s) To Disscuss
Back braceKnee braceWrist braceAnkle braceHip braceElbow brace

Meeting Summary

Initial Method of Contact


Plans


Agent, if the form was signed by the beneficiary at time of appointment, provide
explanation why SOA was not documented prior to the meeting

Beneficiary Agreement

Meeting Date


Meeting Time


Meeting Type


Created Date


Beneficiary or Authorized Representative Signature and Signature Date

Beneficiary Name


Beneficiary Signature Date


Representative's Name


Relationship to Beneficiary







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