payment.patient.athenahealth.com
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54.192.51.85
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Submitted URL: https://ahmsg.us/3HIiXTf
Effective URL: https://payment.patient.athenahealth.com/notification/?token=onCqnfO-qi-Cy74-_X7h
Submission: On January 31 via manual from US — Scanned from US
Effective URL: https://payment.patient.athenahealth.com/notification/?token=onCqnfO-qi-Cy74-_X7h
Submission: On January 31 via manual from US — Scanned from US
Form analysis 1 forms found in the DOM
<form class="form-container">
<p class="instructions-copy">Please verify Meghan’s information for security purposes.</p><label class="form-label" for="last-name-input">Patient Last Name</label>
<div class="fe_c_input__wrapper">
<div class="fe_c_input"><input id="last-name-input" autocomplete="off" class="fe_c_input__input" type="text" value=""></div><svg xmlns="http://www.w3.org/2000/svg" class="fe_c_icon fe_c_icon--success-solid" viewBox="0 0 25 25" aria-hidden="true"
role="img">
<title>Success</title>
<g>
<g class="fe_c_icon__icon fe_c_icon__icon--secondary">
<path d="M12.6 23.2C18.4542 23.2 23.2 18.4542 23.2 12.6C23.2 6.74578 18.4542 2 12.6 2C6.74578 2 2 6.74578 2 12.6C2 18.4542 6.74578 23.2 12.6 23.2Z"></path>
<path d="M7 13.448L10.465 17L18 9"></path>
<path d="M7 13.448L10.465 17L18 9" stroke="white" stroke-width="2" stroke-linecap="round" stroke-linejoin="round"></path>
</g>
</g>
</svg>
</div><label class="form-label" for="dob-input"><span>Patient Date of Birth <span aria-hidden="true" class="fe_u_font-weight--semibold">(MM-DD-YYYY)</span></span></label>
<div class="fe_c_input__wrapper">
<div class="fe_c_input"><input id="dob-input" autocomplete="off" maxlength="10" placeholder="MM-DD-YYYY" class="fe_c_input__input" type="tel" value=""></div><svg xmlns="http://www.w3.org/2000/svg" class="fe_c_icon fe_c_icon--success-solid"
viewBox="0 0 25 25" aria-hidden="true" role="img">
<title>Success</title>
<g>
<g class="fe_c_icon__icon fe_c_icon__icon--secondary">
<path d="M12.6 23.2C18.4542 23.2 23.2 18.4542 23.2 12.6C23.2 6.74578 18.4542 2 12.6 2C6.74578 2 2 6.74578 2 12.6C2 18.4542 6.74578 23.2 12.6 23.2Z"></path>
<path d="M7 13.448L10.465 17L18 9"></path>
<path d="M7 13.448L10.465 17L18 9" stroke="white" stroke-width="2" stroke-linecap="round" stroke-linejoin="round"></path>
</g>
</g>
</svg>
</div><button class="fe_c_fpbutton fe_c_fpbutton--solid-dark fe_c_fpbutton--large fe_c_fpbutton--full-width" disabled="" type="submit" aria-label="Continue" style="pointer-events: none;"> <span>Continue</span></button>
</form>Text Content
WELCOME! Please verify Meghan’s information for security purposes. Patient Last Name Success Patient Date of Birth (MM-DD-YYYY) Success Continue -------------------------------------------------------------------------------- Go to Patient Portal powered by Opens in a new window ¿Prefieres español? Privacy Policy Terms & Conditions Accessibility Statement Note: This page should only be accessed by the patient or those authorized by the patient (e.g. guarantor). By continuing, you represent that you are authorized to address the patient's billing matters. Note: This page should only be accessed by the patient or those authorized by the patient (e.g. guarantor). By continuing, you represent that you are authorized to address the patient's billing matters. powered by Note: This page should only be accessed by the patient or those authorized by the patient (e.g. guarantor). By continuing, you represent that you are authorized to address the patient's billing matters.