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health.questdiagnostics.com Open in urlscan Pro
142.0.160.57  Public Scan

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Submitted URL: http://health.questdiagnostics.com/preferences?utm_medium=email&utm_source=eloqua&elqTrackId=7ecd451836d148f599ad01e4944e8110&elq=e...
Effective URL: https://health.questdiagnostics.com/preferences?utm_medium=email&utm_source=eloqua&elqTrackId=7ecd451836d148f599ad01e4944e8110&elq=e...
Submission: On August 30 via api from US — Scanned from DE

Form analysis 2 forms found in the DOM

Name: QuestDiagnosticsIncorporatedPreferenceCenter — POST https://health.questdiagnostics.com/e/f2

<form method="post" name="QuestDiagnosticsIncorporatedPreferenceCenter" id="form20" action="https://health.questdiagnostics.com/e/f2" lpchecked="1" novalidate="novalidate">
  <input value="QuestDiagnosticsIncorporatedPreferenceCenter" type="hidden" name="elqFormName">
  <input value="2108654627" type="hidden" name="elqSiteId">
  <input name="elqCampaignId" type="hidden" value="1044">
  <div style="margin-bottom:0; margin-top:1px;" class="cogix-msg-alert inlineErrorPlaceholder">
  </div>
  <span id="vwfrequireddataiconsetting" style="display:none;">&nbsp;<font color="#EB931A">*</font></span>
  <div id="contactusptadvocacy1-form-error" class="inlineErrorPlaceholder" style="display: none;">
    <!--Correct the following error(s):-->
    <!--xx-->
  </div>
  <div id="vwfcontactusptadvocacy1req_id" style="display:none"><input type="hidden" id="req_id" name="req_id" value="15bVzVwEsJz2J1qC9aUiJmTdMz"></div>
  <div id="vwfcontactusptadvocacy1heading" class="additional-top-margin-big">
    <h1>Keep your contact information up-to-date</h1>
  </div>
  <div id="notyou" style="">Welcome <span>bagis@ccf.org</span>. Not you? <a id="notyouclick" style="cursor: pointer;">Click here</a>, or <a id="change-email-click">change
                                                email</a>.</div>
  <div id="vwfcontactusptadvocacy1intro">
    <div style="margin-top: 1em; margin-bottom: 1em;">Your latest contact information is below. Please update anything that has changed or that needs to be corrected.</div>
  </div>
  <!-- <div id="change-email" style="display:none"><a id="change-email-click">change
                                                email</a></div> -->
  <div id="vwfcontactusptadvocacy1required"> <span style="color: #EB931A">*</span> Indicates required fields </div>
  <div class="container">
    <div class="row">
      <div class="col-md-6">
        <fieldset style="border-style:none; border-width:1px; border-color:#DDDDDD; margin: 2px 0px 2px 0px; padding: 6px 6px 6px 6px;" id="vwfcontactusptadvocacy1first_name">
          <div class="cogix-section-body" style="margin-bottom:4px; margin-top:1px; font-weight:inherit"><span class="cogix-msg-alert inlineErrorPlaceholder"></span>
            <label for="first_name"><strong>First name</strong>&nbsp;<font color="#EB931A">*</font></label>
          </div>
          <input class="cogix-form-input-field" id="first_name" type="text" name="firstName" value="Stephanie" size="38">
        </fieldset>
      </div>
      <div class="col-md-6">
        <fieldset style="border-style:none; border-width:1px; border-color:#DDDDDD; margin: 2px 0px 2px 0px; padding: 6px 6px 6px 6px;" id="vwfcontactusptadvocacy1last_name">
          <div class="cogix-section-body" style="margin-bottom:4px; margin-top:1px; font-weight:inherit"><span class="cogix-msg-alert inlineErrorPlaceholder"></span>
            <label for="last_name"><strong>Last name</strong>&nbsp;<font color="#EB931A">*</font></label>
          </div>
          <input class="cogix-form-input-field" id="last_name" type="text" name="lastName" value="Bagi" size="38">
        </fieldset>
      </div>
      <div class="col-md-6">
        <fieldset id="oldEmailField" style="border-style:none; border-width:1px; border-color:#DDDDDD; margin: 2px 0px 2px 0px; padding: 6px 6px 6px 6px;">
          <div class="cogix-section-body" style="margin-bottom:4px; margin-top:1px; font-weight:inherit"><span class="cogix-msg-alert inlineErrorPlaceholder"></span>
            <label for="email"><strong>Email</strong>&nbsp;<font id="email-required" color="#EB931A">*</font></label>
          </div>
          <span id="emailmsg1" style="color: red;"></span>
          <input class="cogix-form-input-field" id="email" required="" type="text" name="emailAddress" value="bagis@ccf.org" size="38">
        </fieldset>
      </div>
      <div class="col-md-6" style="display:none">
        <fieldset id="newEmailField" style="border-style:none; border-width:1px; border-color:#DDDDDD; margin: 2px 0px 2px 0px; padding: 6px 6px 6px 6px;">
          <div class="cogix-section-body" style="margin-bottom:4px; margin-top:1px; font-weight:inherit"><span class="cogix-msg-alert inlineErrorPlaceholder"></span>
            <label for="newEmail"><strong>New email address</strong></label>
          </div>
          <span id="emailmsg1" style="color: red;"></span>
          <input class="cogix-form-input-field" id="newEmail" type="text" name="newEmail" size="38">
        </fieldset>
      </div>
      <div class="col-md-6">
        <fieldset style="border-style:none; border-width:1px; border-color:#DDDDDD; margin: 2px 0px 2px 0px; padding: 6px 6px 6px 6px;">
          <div class="cogix-section-body" style="margin-bottom:4px; margin-top:1px; font-weight:inherit"><span class="cogix-msg-alert inlineErrorPlaceholder"></span>
            <label for="busPhone"><strong>Business Phone</strong></label>
          </div>
          <input class="cogix-form-input-field" id="busPhone" type="text" name="busPhone" value="216.444.2200" size="38">
        </fieldset>
      </div>
      <div class="col-md-6">
        <fieldset style="border-style:none; border-width:1px; border-color:#DDDDDD; margin: 2px 0px 2px 0px; padding: 6px 6px 6px 6px;">
          <div class="cogix-section-body" style="margin-bottom:4px; margin-top:1px; font-weight:inherit"><span class="cogix-msg-alert inlineErrorPlaceholder"></span>
            <label for="company"><strong>Company</strong></label>
          </div>
          <input class="cogix-form-input-field" id="company" type="text" name="company" value="Cleveland Clinic - Main Campus" size="38">
        </fieldset>
      </div>
      <div class="col-md-6">
        <fieldset style="border-style:none; border-width:1px; border-color:#DDDDDD; margin: 2px 0px 2px 0px; padding: 6px 6px 6px 6px;">
          <div class="cogix-section-body" style="margin-bottom:4px; margin-top:1px; font-weight:inherit"><span class="cogix-msg-alert inlineErrorPlaceholder"></span>
            <label for="city"><strong>City</strong></label>
          </div>
          <input class="cogix-form-input-field" id="city" type="text" name="city" value="Cleveland" size="38">
        </fieldset>
      </div>
      <div class="col-md-6">
        <fieldset style="border-style:none; border-width:1px; border-color:#DDDDDD; margin: 2px 0px 2px 0px; padding: 6px 6px 6px 6px;">
          <div class="cogix-section-body" style="margin-bottom:4px; margin-top:1px; font-weight:inherit"><span class="cogix-msg-alert inlineErrorPlaceholder"></span>
            <label for="country"><strong>Country</strong> &nbsp;<font color="#EB931A">*</font>
            </label>
          </div>
          <div class="select-list-div">
            <select id="country" name="country" class="select-list" data-value="">
              <option value=""> Please select </option>
              <option value="US"> United States </option>
              <option value="GB"> United Kingdom </option>
              <option value="CA"> Canada </option>
              <option value="IN"> India </option>
              <option value="NL"> Netherlands </option>
              <option value="AU"> Australia </option>
              <option value="ZA"> South Africa </option>
              <option value="FR"> France </option>
              <option value="DE"> Germany </option>
              <option value="SG"> Singapore </option>
              <option value="SE"> Sweden </option>
              <option value="BR"> Brazil </option>
              <option value=""> -------------- </option>
              <option value="AF"> Afghanistan </option>
              <option value="AX"> Åland Islands </option>
              <option value="AL"> Albania </option>
              <option value="DZ"> Algeria </option>
              <option value="AS"> American Samoa </option>
              <option value="AD"> Andorra </option>
              <option value="AO"> Angola </option>
              <option value="AI"> Anguilla </option>
              <option value="AQ"> Antarctica </option>
              <option value="AG"> Antigua and Barbuda </option>
              <option value="AR"> Argentina </option>
              <option value="AM"> Armenia </option>
              <option value="AW"> Aruba </option>
              <option value="AU"> Australia </option>
              <option value="AT"> Austria </option>
              <option value="AZ"> Azerbaijan </option>
              <option value="BS"> Bahamas </option>
              <option value="BH"> Bahrain </option>
              <option value="BD"> Bangladesh </option>
              <option value="BB"> Barbados </option>
              <option value="BY"> Belarus </option>
              <option value="BE"> Belgium </option>
              <option value="BZ"> Belize </option>
              <option value="BJ"> Benin </option>
              <option value="BM"> Bermuda </option>
              <option value="BT"> Bhutan </option>
              <option value="BO"> Bolivia </option>
              <option value="BA"> Bosnia and Herzegovina </option>
              <option value="BW"> Botswana </option>
              <option value="BV"> Bouvet Island </option>
              <option value="BR"> Brazil </option>
              <option value="IO"> Brit/Indian Ocean Terr. </option>
              <option value="BN"> Brunei Darussalam </option>
              <option value="BG"> Bulgaria </option>
              <option value="BF"> Burkina Faso </option>
              <option value="BI"> Burundi </option>
              <option value="KH"> Cambodia </option>
              <option value="CM"> Cameroon </option>
              <option value="CA"> Canada </option>
              <option value="CV"> Cape Verde </option>
              <option value="KY"> Cayman Islands </option>
              <option value="CF"> Central African Republic </option>
              <option value="TD"> Chad </option>
              <option value="CL"> Chile </option>
              <option value="CN"> China </option>
              <option value="CX"> Christmas Island </option>
              <option value="CC"> Cocos (Keeling) Islands </option>
              <option value="CO"> Colombia </option>
              <option value="KM"> Comoros </option>
              <option value="CG"> Congo </option>
              <option value="CD"> Congo, The Dem. Republic Of </option>
              <option value="CK"> Cook Islands </option>
              <option value="CR"> Costa Rica </option>
              <option value="CI"> Côte d'Ivoire </option>
              <option value="HR"> Croatia </option>
              <option value="CU"> Cuba </option>
              <option value="CY"> Cyprus </option>
              <option value="CZ"> Czech Republic </option>
              <option value="DK"> Denmark </option>
              <option value="DJ"> Djibouti </option>
              <option value="DM"> Dominica </option>
              <option value="DO"> Dominican Republic </option>
              <option value="EC"> Ecuador </option>
              <option value="EG"> Egypt </option>
              <option value="SV"> El Salvador </option>
              <option value="GQ"> Equatorial Guinea </option>
              <option value="ER"> Eritrea </option>
              <option value="EE"> Estonia </option>
              <option value="ET"> Ethiopia </option>
              <option value="FK"> Falkland Islands </option>
              <option value="FO"> Faroe Islands </option>
              <option value="FJ"> Fiji </option>
              <option value="FI"> Finland </option>
              <option value="FR"> France </option>
              <option value="GF"> French Guiana </option>
              <option value="PF"> French Polynesia </option>
              <option value="TF"> French Southern Terr. </option>
              <option value="GA"> Gabon </option>
              <option value="GM"> Gambia </option>
              <option value="GE"> Georgia </option>
              <option value="DE"> Germany </option>
              <option value="GH"> Ghana </option>
              <option value="GI"> Gibraltar </option>
              <option value="GB"> United Kingdom </option>
              <option value="GR"> Greece </option>
              <option value="GL"> Greenland </option>
              <option value="GD"> Grenada </option>
              <option value="GP"> Guadeloupe </option>
              <option value="GU"> Guam </option>
              <option value="GT"> Guatemala </option>
              <option value="GN"> Guinea </option>
              <option value="GW"> Guinea-Bissau </option>
              <option value="GY"> Guyana </option>
              <option value="HT"> Haiti </option>
              <option value="HM"> Heard/McDonald Isls. </option>
              <option value="HN"> Honduras </option>
              <option value="HK"> Hong Kong </option>
              <option value="HU"> Hungary </option>
              <option value="IS"> Iceland </option>
              <option value="IN"> India </option>
              <option value="ID"> Indonesia </option>
              <option value="IR"> Iran </option>
              <option value="IQ"> Iraq </option>
              <option value="IE"> Ireland </option>
              <option value="IL"> Israel </option>
              <option value="IT"> Italy </option>
              <option value="JM"> Jamaica </option>
              <option value="JP"> Japan </option>
              <option value="JO"> Jordan </option>
              <option value="KZ"> Kazakhstan </option>
              <option value="KE"> Kenya </option>
              <option value="KI"> Kiribati </option>
              <option value="KP"> Korea (North) </option>
              <option value="KR"> Korea (South) </option>
              <option value="KW"> Kuwait </option>
              <option value="KG"> Kyrgyzstan </option>
              <option value="LA"> Laos </option>
              <option value="LV"> Latvia </option>
              <option value="LB"> Lebanon </option>
              <option value="LS"> Lesotho </option>
              <option value="LR"> Liberia </option>
              <option value="LY"> Libya </option>
              <option value="LI"> Liechtenstein </option>
              <option value="LT"> Lithuania </option>
              <option value="LU"> Luxembourg </option>
              <option value="MO"> Macau </option>
              <option value="MK"> Macedonia </option>
              <option value="MG"> Madagascar </option>
              <option value="MW"> Malawi </option>
              <option value="MY"> Malaysia </option>
              <option value="MV"> Maldives </option>
              <option value="ML"> Mali </option>
              <option value="MT"> Malta </option>
              <option value="MH"> Marshall Islands </option>
              <option value="MQ"> Martinique </option>
              <option value="MR"> Mauritania </option>
              <option value="MU"> Mauritius </option>
              <option value="YT"> Mayotte </option>
              <option value="MX"> Mexico </option>
              <option value="FM"> Micronesia </option>
              <option value="MD"> Moldova </option>
              <option value="MC"> Monaco </option>
              <option value="MN"> Mongolia </option>
              <option value="MS"> Montserrat </option>
              <option value="MA"> Morocco </option>
              <option value="MZ"> Mozambique </option>
              <option value="MM"> Myanmar </option>
              <option value="MP"> N. Mariana Isls. </option>
              <option value="NA"> Namibia </option>
              <option value="NR"> Nauru </option>
              <option value="NP"> Nepal </option>
              <option value="NL"> Netherlands </option>
              <option value="AN"> Netherlands Antilles </option>
              <option value="NC"> New Caledonia </option>
              <option value="NZ"> New Zealand </option>
              <option value="NI"> Nicaragua </option>
              <option value="NE"> Niger </option>
              <option value="NG"> Nigeria </option>
              <option value="NU"> Niue </option>
              <option value="NF"> Norfolk Island </option>
              <option value="NO"> Norway </option>
              <option value="OM"> Oman </option>
              <option value="PK"> Pakistan </option>
              <option value="PW"> Palau </option>
              <option value="PS"> Palestinian Territory, Occupied </option>
              <option value="PA"> Panama </option>
              <option value="PG"> Papua New Guinea </option>
              <option value="PY"> Paraguay </option>
              <option value="PE"> Peru </option>
              <option value="PH"> Philippines </option>
              <option value="PN"> Pitcairn </option>
              <option value="PL"> Poland </option>
              <option value="PT"> Portugal </option>
              <option value="PR"> Puerto Rico </option>
              <option value="QA"> Qatar </option>
              <option value="RE"> Reunion </option>
              <option value="RO"> Romania </option>
              <option value="RU"> Russian Federation </option>
              <option value="RW"> Rwanda </option>
              <option value="KN"> Saint Kitts and Nevis </option>
              <option value="LC"> Saint Lucia </option>
              <option value="WS"> Samoa </option>
              <option value="SM"> San Marino </option>
              <option value="ST"> Sao Tome/Principe </option>
              <option value="SA"> Saudi Arabia </option>
              <option value="SN"> Senegal </option>
              <option value="CS"> Serbia and Montenegro </option>
              <option value="SC"> Seychelles </option>
              <option value="SL"> Sierra Leone </option>
              <option value="SG"> Singapore </option>
              <option value="SK"> Slovak Republic </option>
              <option value="SI"> Slovenia </option>
              <option value="SB"> Solomon Islands </option>
              <option value="SO"> Somalia </option>
              <option value="ZA"> South Africa </option>
              <option value="ES"> Spain </option>
              <option value="LK"> Sri Lanka </option>
              <option value="SH"> St. Helena </option>
              <option value="PM"> St. Pierre and Miquelon </option>
              <option value="VC"> St. Vincent and Grenadines </option>
              <option value="SD"> Sudan </option>
              <option value="SR"> Suriname </option>
              <option value="SJ"> Svalbard/Jan Mayen Isls. </option>
              <option value="SZ"> Swaziland </option>
              <option value="SE"> Sweden </option>
              <option value="CH"> Switzerland </option>
              <option value="SY"> Syria </option>
              <option value="TW"> Taiwan </option>
              <option value="TJ"> Tajikistan </option>
              <option value="TZ"> Tanzania </option>
              <option value="TH"> Thailand </option>
              <option value="TL"> Timor-Leste </option>
              <option value="TG"> Togo </option>
              <option value="TK"> Tokelau </option>
              <option value="TO"> Tonga </option>
              <option value="TT"> Trinidad and Tobago </option>
              <option value="TN"> Tunisia </option>
              <option value="TR"> Turkey </option>
              <option value="TM"> Turkmenistan </option>
              <option value="TC"> Turks/Caicos Isls. </option>
              <option value="TV"> Tuvalu </option>
              <option value="UG"> Uganda </option>
              <option value="UA"> Ukraine </option>
              <option value="AE"> United Arab Emirates </option>
              <option value="US"> United States </option>
              <option value="UM"> US Minor Outlying Is. </option>
              <option value="UY"> Uruguay </option>
              <option value="UZ"> Uzbekistan </option>
              <option value="VU"> Vanuatu </option>
              <option value="VA"> Vatican City </option>
              <option value="VE"> Venezuela </option>
              <option value="VN"> Viet Nam </option>
              <option value="VG"> Virgin Islands (British) </option>
              <option value="VI"> Virgin Islands (U.S.) </option>
              <option value="WF"> Wallis/Futuna Isls. </option>
              <option value="EH"> Western Sahara </option>
              <option value="YE"> Yemen </option>
              <option value="ZM"> Zambia </option>
              <option value="ZW"> Zimbabwe </option>
            </select>
          </div>
        </fieldset>
      </div>
      <div class="col-md-6" id="state-field" style="display: none;">
        <fieldset id="state-field-us" style="border-style:none; border-width:1px; border-color:#DDDDDD; margin: 2px 0px 2px 0px; padding: 6px 6px 6px 6px;">
          <div class="cogix-section-body" style="margin-bottom:4px; margin-top:1px; font-weight:inherit"><span class="cogix-msg-alert inlineErrorPlaceholder"></span>
            <label for="stateProv"><strong>State or Province</strong>
              <font color="#EB931A">*</font>
            </label>
          </div>
          <div class="select-list-div">
            <select required="" id="stateProv" name="stateProv" data-value="OH" class="select-list"></select>
          </div>
        </fieldset>
      </div>
    </div>
  </div>
  <div id="vwfcontactusptadvocacy1nature_hd">
    <div style="margin-top: 1em; margin-bottom: 1em;">Select the type of updates you would like to receive.</div>
  </div>
  <div class="container">
    <h3>For Healthcare Providers</h3>
    <div class="row">
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="MedicalEducation" data-subscription="true" value="on" style="opacity: 1;"><span>Medical education:</span> Webinars, newsletters, clinical expert insights </label>
        </div>
      </div>
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="Provider" data-subscription="true" value="on" style="opacity: 1;"><span>Provider updates:</span> General communications for Healthcare Providers</label>
        </div>
      </div>
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="Provider" data-subscription="true" value="on" style="opacity: 1;"><span>Primary Insights:</span> Updates on timely, disease-specific topics</label>
        </div>
      </div>
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="Clinical" data-subscription="true" value="on" style="opacity: 1;"><span>Clinical updates:</span> Special announcements on test updates and new test launches</label>
        </div>
      </div>
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="Regional" data-subscription="true" value="on" style="opacity: 1;"><span>Regional updates:</span> Local events and information</label>
        </div>
      </div>
      <div class="col-md-6">
        <div class="checkbox">
          <label><input name="DrugMonitoring" type="checkbox" value="on" data-subscription="true" style="opacity: 1;"><span>Drug Monitoring:</span> Updates on drug monitoring content</label>
        </div>
      </div>
      <!--div class="col-md-6">
                                                    <div class="checkbox">
                                                        <label><input type="checkbox" class="check-item" name="Quanum" data-subscription="true" value="on"><span>Workflow, utilization, and analytics:</span>
                                                            Quanum™
                                                            health information technology suite</label>
                                                    </div>
                                                </div>
												<div class="col-md-6">
                                                    <div class="checkbox">
                                                        <label><input type="checkbox" class="check-item" name="QuanumProvider" data-subscription="true" value="on"><span>Inbox Insights:</span> Quanum healthcare IT quarterly newsletter</label>
                                                    </div>
                                                </div-->
    </div>
    <h3>For Health Systems</h3>
    <div class="row">
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="HealthSystems" data-subscription="true" value="on" style="opacity: 1;"><span>Newsletter:</span> Efficiency, lowering cost of testing, achieving quality care </label>
        </div>
      </div>
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="QuanumEnterprise" data-subscription="true" value="on" style="opacity: 1;"><span>Enterprise Update:</span> Quanum enterprise content solutions quarterly newsletter</label>
        </div>
      </div>
    </div>
    <h3>For Health Plans</h3>
    <div class="row">
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="HealthPlansEducation" data-subscription="true" value="on" style="opacity: 1;"><span>Education:</span> Tools, resources, white papers, case studies, and webinars </label>
        </div>
      </div>
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="HealthPlansPromotional" data-subscription="true" value="on" style="opacity: 1;"><span>Special announcements:</span> Announcements and updates about Quest solutions and services</label>
        </div>
      </div>
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="HealthyInsights" data-subscription="true" value="on" style="opacity: 1;"><span>Healthy insights:</span> Quarterly customer newsletter</label>
        </div>
      </div>
    </div>
    <h3>For Federally Qualified Health Centers (FQHC)</h3>
    <div class="row">
      <div class="col-md-6">
        <div class="checkbox">
          <label><input type="checkbox" class="check-item" name="FederallyQualifiedHealthCenters" data-subscription="true" value="on" style="opacity: 1;"><span>Quest and Community Health:</span> Updates, tips, curated content, and info about upcoming
            webinars and recent studies </label>
        </div>
      </div>
    </div>
    <div class="row additional-top-margin">
      <div class="col-md-12">
        <p class="bold">If you would no longer like to receive any email marketing communications from Quest or its subsidiaries (including ExamOne, Sonora Quest, and more), please check the box below. Please note that you will continue to receive
          relevant transactional messages from Quest.</p>
      </div>
    </div>
    <div class="row">
      <div class="col-md-6">
        <div class="checkbox">
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