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Form analysis
1 forms found in the DOM

POST

<form class="form-horizontal" action="" method="POST" id="contact-form" novalidate="">
  <div class="form-group">
    <label class="control-label col-md-4 col-sm-3">First name</label>
    <div class="col-md-8 col-sm-9">
      <input class="form-control" type="text" placeholder="First name" value="" name="firstname">
    </div>
  </div>
  <div class="form-group">
    <label class="control-label col-md-4 col-sm-3">Last name</label>
    <div class="col-md-8 col-sm-9">
      <input class="form-control" type="text" placeholder="Last name" value="" name="lastname">
    </div>
  </div>
  <div class="form-group">
    <label class="control-label col-md-4 col-sm-3">Email address</label>
    <div class="col-md-8 col-sm-9">
      <input class="form-control" type="email" placeholder="Email address" value="" name="email">
    </div>
  </div>
  <div class="form-group">
    <label class="control-label col-md-4 col-sm-3">Phone number <small style="display: block; font-size: 12px; line-height: 14px; font-weight: normal; color: #677b93;">Optional</small>
    </label>
    <div class="col-md-8 col-sm-9">
      <input class="form-control" type="tel" placeholder="Phone number (optional)" value="" name="phone">
    </div>
  </div>
  <div class="form-group">
    <label class="control-label col-md-4 col-sm-3"> Message </label>
    <div class="col-md-8 col-sm-9">
      <div class="pull-right"> Is this regarding a CE activity? <label style="border:1px solid #ccc; padding:2px 5px; cursor:pointer;">
          <input type="radio" name="ce-activity" value="yes" class="form-inine ce-activity-toggle">Yes </label>
        <label style="border:1px solid #ccc; padding:2px 5px; cursor:pointer;">
          <input type="radio" name="ce-activity" value="no" class="form-inine ce-activity-toggle">No </label>
      </div>
      <div id="ce-activity-request" class="alert alert-warning" style="display:none; clear:both; background:#fec;">
        <p>Most actions can be completed from your <a href="https://primeinc.org/account" target="_blank">CME Tracker</a> and do not require assistance. If you still need help, please include enough information so we can rapidly assist you:<br><br>
        </p>
        <ul>
          <li>The type of activity (e.g. online video, live webinar)</li>
          <li>Activity URL (preferred) or the title/topic</li>
          <li>Date and time of completion</li>
          <li>Email address used, if different than above</li>
          <li>Clear explanation of the issue</li>
        </ul>
      </div>
      <textarea class="form-control" name="message" rows="5" placeholder="Type your message here..."></textarea>
    </div>
  </div>
  <div class="text-center"> By clicking Submit, you agree to PRIME Education, LLC's <a href="https://primeinc.org/terms" target="_blank">Terms of Use</a> and <a href="https://primeinc.org/privacy" target="_blank">Privacy Policy</a><br>. </div>
  <div class="text-center">
    <input type="submit" class="btn btn-lg btn-primary" value="Submit">
  </div>
</form>

Text Content

PRIME Education
 * About PRIME
   * Overview
   * Leadership
   * Science of CME
   * Careers
 * Our Work
   * Overview
   * Systems-Based Change and Quality Improvement
   * Payers and Value-Based Care
   * Global
   * Government
   * Patients and Providers
 * Awards
 * Home
 * Publications
 * Press
   * Recent
   * 2021
   * 2020
   * 2019
   * 2018
   * 2017
 * Contact Us

--------------------------------------------------------------------------------

PRIME Education

 * About PRIME
   * Overview
   * Leadership
   * Science of CME
   * Careers
 * Our Work
   * Overview
   * Systems-Based Change and Quality Improvement
   * Payers and Value-Based Care
   * Global
   * Government
   * Patients and Providers
 * Awards
 * Home
 * Publications
 * Press
   * Recent
   * 2021
   * 2020
   * 2019
   * 2018
   * 2017
 * Contact Us




CONTACT US


FOR SUPPORT, QUESTIONS ABOUT PRIME, OR MORE INFORMATION, YOU MAY REACH US...

BY PHONE

(954) 718-6055
Monday — Friday
8:00 AM — 6:00 PM ET

--------------------------------------------------------------------------------

BY MAIL

PRIME Education, LLC
5900 N Andrews Ave, Suite 500
Fort Lauderdale, FL 33309




OR BY EMAIL:



First name

Last name

Email address

Phone number Optional

Message
Is this regarding a CE activity? Yes No

Most actions can be completed from your CME Tracker and do not require
assistance. If you still need help, please include enough information so we can
rapidly assist you:



 * The type of activity (e.g. online video, live webinar)
 * Activity URL (preferred) or the title/topic
 * Date and time of completion
 * Email address used, if different than above
 * Clear explanation of the issue

By clicking Submit, you agree to PRIME Education, LLC's Terms of Use and Privacy
Policy
.


PRIME Education, LLC
a property of
Everyday Health Group
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Facebook


PRIME

 * About PRIME
 * Privacy Policy
 * Terms of Use
 * Contact PRIME
 * Accessibility Statement
 * Do Not Sell My Personal Information

PRIME Network

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 * MilitaryCME.com
 * ManagedCare.network
 * AfterMD.com

PRIME Corporate

 * Our Work
 * Awards
 * Publications
 * Press
 * Careers



© 1997–2021 PRIME Education, LLC

5900 N Andrews Avenue, Suite #500, Fort Lauderdale, FL 33309

×

PATIENT-PROVIDER MODEL OF LEARNING