sophos.providerhealthservices.net
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66.194.155.167
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URL:
https://sophos.providerhealthservices.net/register/001U2FsdGVkX1_Nh2WSUU7HpP1cU9Cd99gh1L0eSjro8aCWM4Apcw45Lw/
Submission: On May 12 via manual from US — Scanned from DE
Submission: On May 12 via manual from US — Scanned from DE
Form analysis
1 forms found in the DOMPOST register
<form method="POST" autocomplete="off" enctype="multipart/form-data" action="register">
<div id="pw_requirements">
<div id="pw_requirements_header"><b>Password Requirements:</b></div>
<ul id="pw_requirements_list">
<li>
<div id="password_length" class="pw_requirement_img" style="background-position: 0px -16px;"></div>
<div class="pw_requirement_txt">Passwords must be 8-32 characters in length</div>
</li>
<li>
<div id="password_contains_alphanumeric" class="pw_requirement_img" style="background-position: 0px -16px;"></div>
<div class="pw_requirement_txt">Passwords must be alphanumeric</div>
</li>
<li>
<div id="passwords_match" class="pw_requirement_img" style="background-position: 0px -16px;"></div>
<div class="pw_requirement_txt">Passwords must match</div>
</li>
</ul>
</div>
<div id="form_box">
<fieldset style="border:none"><label for="currentemail_register_page" class="register_label"><b>Email Address:</b></label><input type="text" id="currentemail_register_page" class="register_top_fieldset" name="currentemail" size="32" disabled=""
value="sanders@ochsner.org">
<div class="separator"></div><label for="new_password" class="register_label"><b>Password:</b></label><input type="password" id="new_password" class="register_top_fieldset" name="password" size="32" maxlength="32" onkeyup="rf_init_validate();"
autocomplete="off">
<div class="separator"></div><label for="confirm_password" class="register_label"><b>Confirm password:</b></label><input type="password" id="confirm_password" class="register_top_fieldset" name="confirm" size="32" maxlength="32"
onkeyup="rf_init_validate();" autocomplete="off">
<div class="separator"></div>
</fieldset>
</div>
<div width="100%">
<fieldset class="qa_fieldset">
<legend id="qa_group_legend"><span id="qa_header_outer"><b>Password Reset/Recovery:</b></span><span id="qa_question_toggle" style="display:none;"><input type="checkbox" name="enable_questions" id="enable_questions"
onchange="rf_toggle_qa_group()" onclick="rf_toggle_qa_group()"><label for="enable_questions">Update password change/reset question(s)</label></span></legend>
<div id="qa_header_inner" style="display:none;"><b>Password Reset/Recovery:</b></div>
<div class="qa_desc">Password questions and answers must be unique. Answers must contain at least 2 characters.</div>
<div><label class="qa_label" for="default_question1_sel"><b>Question 1:</b></label>
<div class="qa_select"><select id="default_question1_sel" name="question1" onchange="rf_update_state();">
<option value="0" id="register-default-question0">Please choose a question</option>
<option value="1" id="register-default-question1">What was your childhood nickname?</option>
<option value="2" id="register-default-question2">In what city did you meet your spouse/significant other?</option>
<option value="3" id="register-default-question3">What is the name of your favorite childhood friend?</option>
<option value="4" id="register-default-question4">What street did you live on as a child?</option>
<option value="5" id="register-default-question5">What is your oldest sibling's middle name?</option>
<option value="6" id="register-default-question6">What is the name of your favorite childhood pet?</option>
<option value="7" id="register-default-question7">In what city or town did your mother and father meet?</option>
<option value="8" id="register-default-question8">In what city does your nearest sibling live?</option>
<option value="9" id="register-default-question9">What is the name of the company of your first job?</option>
<option value="10" id="register-default-question10">What was your favorite place to visit as a child?</option>
<option value="11" id="register-default-question11">What was the make and model of your first car?</option>
</select></div>
<div class="separator"></div><label class="qa_label" for="security_answer1_txt"><b>Answer:</b></label>
<div class="qa_answer"><input type="text" size="58" maxlength="64" onkeyup="rf_update_state();" autocomplete="off" name="answer1" id="security_answer1_txt"></div>
<div class="separator"></div><label class="qa_label" for="default_question2_sel"><b>Question 2:</b></label>
<div class="qa_select"><select id="default_question2_sel" name="question2" onchange="rf_update_state();">
<option value="0" id="register-default-question0">Please choose a question</option>
<option value="1" id="register-default-question1">What was your childhood nickname?</option>
<option value="2" id="register-default-question2">In what city did you meet your spouse/significant other?</option>
<option value="3" id="register-default-question3">What is the name of your favorite childhood friend?</option>
<option value="4" id="register-default-question4">What street did you live on as a child?</option>
<option value="5" id="register-default-question5">What is your oldest sibling's middle name?</option>
<option value="6" id="register-default-question6">What is the name of your favorite childhood pet?</option>
<option value="7" id="register-default-question7">In what city or town did your mother and father meet?</option>
<option value="8" id="register-default-question8">In what city does your nearest sibling live?</option>
<option value="9" id="register-default-question9">What is the name of the company of your first job?</option>
<option value="10" id="register-default-question10">What was your favorite place to visit as a child?</option>
<option value="11" id="register-default-question11">What was the make and model of your first car?</option>
</select></div>
<div class="separator"></div><label class="qa_label" for="security_answer2_txt"><b>Answer:</b></label>
<div class="qa_answer"><input type="text" size="58" maxlength="64" onkeyup="rf_update_state();" autocomplete="off" name="answer2" id="security_answer2_txt"></div>
<div class="separator"></div><label class="qa_label" for="default_question3_sel"><b>Question 3:</b></label>
<div class="qa_select"><select id="default_question3_sel" name="question3" onchange="rf_update_state();">
<option value="0" id="register-default-question0">Please choose a question</option>
<option value="1" id="register-default-question1">What was your childhood nickname?</option>
<option value="2" id="register-default-question2">In what city did you meet your spouse/significant other?</option>
<option value="3" id="register-default-question3">What is the name of your favorite childhood friend?</option>
<option value="4" id="register-default-question4">What street did you live on as a child?</option>
<option value="5" id="register-default-question5">What is your oldest sibling's middle name?</option>
<option value="6" id="register-default-question6">What is the name of your favorite childhood pet?</option>
<option value="7" id="register-default-question7">In what city or town did your mother and father meet?</option>
<option value="8" id="register-default-question8">In what city does your nearest sibling live?</option>
<option value="9" id="register-default-question9">What is the name of the company of your first job?</option>
<option value="10" id="register-default-question10">What was your favorite place to visit as a child?</option>
<option value="11" id="register-default-question11">What was the make and model of your first car?</option>
</select></div>
<div class="separator"></div><label class="qa_label" for="security_answer3_txt"><b>Answer:</b></label>
<div class="qa_answer"><input type="text" size="58" maxlength="64" onkeyup="rf_update_state();" autocomplete="off" name="answer3" id="security_answer3_txt"></div>
<div class="separator"></div>
</div>
</fieldset>
<div id="register_submit"><input type="hidden" name="existing_answer_string" value="<use existing answer>"><input type="submit" id="register_btn" name="register_action" value="Register" disabled=""></div>
</div>
</form>
Text Content
SET YOUR PASSWORD BELOW TO ACCESS SECURE EMAILS YOU HAVE BEEN SENT. Password Requirements: * Passwords must be 8-32 characters in length * Passwords must be alphanumeric * Passwords must match Email Address: Password: Confirm password: Password Reset/Recovery:Update password change/reset question(s) Password Reset/Recovery: Password questions and answers must be unique. Answers must contain at least 2 characters. Question 1: Please choose a questionWhat was your childhood nickname?In what city did you meet your spouse/significant other?What is the name of your favorite childhood friend?What street did you live on as a child?What is your oldest sibling's middle name?What is the name of your favorite childhood pet?In what city or town did your mother and father meet?In what city does your nearest sibling live?What is the name of the company of your first job?What was your favorite place to visit as a child?What was the make and model of your first car? Answer: Question 2: Please choose a questionWhat was your childhood nickname?In what city did you meet your spouse/significant other?What is the name of your favorite childhood friend?What street did you live on as a child?What is your oldest sibling's middle name?What is the name of your favorite childhood pet?In what city or town did your mother and father meet?In what city does your nearest sibling live?What is the name of the company of your first job?What was your favorite place to visit as a child?What was the make and model of your first car? Answer: Question 3: Please choose a questionWhat was your childhood nickname?In what city did you meet your spouse/significant other?What is the name of your favorite childhood friend?What street did you live on as a child?What is your oldest sibling's middle name?What is the name of your favorite childhood pet?In what city or town did your mother and father meet?In what city does your nearest sibling live?What is the name of the company of your first job?What was your favorite place to visit as a child?What was the make and model of your first car? Answer: