member.doctorcareanywhere.com Open in urlscan Pro
52.178.222.32  Public Scan

Form analysis
1 forms found in the DOM

POST /SignUp/VoucherAccountInformation

<form action="/SignUp/VoucherAccountInformation" autocomplete="off" data-validation="password" id="voucherAccountInformationForm" method="post" novalidate="novalidate"><input name="__RequestVerificationToken" type="hidden"
    value="jj6zcE2Vrj7MYPaJD0sAxwXiMA30SRG4eodNQfiPbr48MKDuF2XdKKv7WDezOATXN7n0XGJR5MMEvJ5pq12DPbOcdr01"><input id="ExternalReference" name="ExternalReference" type="hidden" value="">
  <div class="left-col-inner border-bottom">
    <div class="inner-top style-1-a">
      <h3 class="blue">
        <i class="icon-mail-in-circle"></i> Tus detalles
      </h3>
    </div>
    <fieldset class="form-row">
      <div class="label-wrap">
        <label class="bolded" for="FirstName">Nombre</label>
      </div>
      <div class="long">
        <input class="in-text capitalize mp-no-track" data-val="true" data-val-maxlength="AccountFirstNameMaxLengthExceeded" data-val-maxlength-max="70" data-val-name="First name contains forbidden characters"
          data-val-required="Se requiere el primer nombre" id="FirstName" maxlength="100" name="FirstName" placeholder="Ingrese nombre ..." type="text" value="">
      </div>
      <span class="error-text bottom-text">
        <span class="field-validation-valid" data-valmsg-for="FirstName" data-valmsg-replace="true"></span>
      </span>
    </fieldset>
    <fieldset class="form-row">
      <div class="label-wrap">
        <label class="bolded" for="LastName">Apellidos</label>
      </div>
      <div class="long">
        <input class="in-text capitalize mp-no-track" data-val="true" data-val-maxlength="AccountLastNameMaxLengthExceeded" data-val-maxlength-max="70" data-val-name="Surname contains forbidden characters"
          data-val-required="El apellido es obligatorio" id="LastName" maxlength="100" name="LastName" placeholder="Introduce el apellido ..." type="text" value="">
      </div>
      <span class="error-text bottom-text">
        <span class="field-validation-valid" data-valmsg-for="LastName" data-valmsg-replace="true"></span>
      </span>
    </fieldset>
    <fieldset class="form-row">
      <legend></legend>
      <div class="label-wrap">
        <label class="bolded" for="DateOfBirth">Fecha de nacimiento</label>
      </div>
      <div class="long">
        <div class="threefielddatetime">
          <div class="third" id="DateOfBirth_DayList">
            <div class="selectric-wrapper selectric-_day selectric-mp-no-track">
              <div class="selectric-hide-select"><select class="_day mp-no-track" data-val="true" data-val-date="The field Fecha de nacimiento must be a date." data-val-minage="Debe tener al menos 18 años de edad para registrar una cuenta"
                  data-val-minage-min="18" data-val-threefielddate="VerifyDateOfBirthInvalid" data-val-threefielddate-disablestandarddatevalidation="True" id="DateOfBirth_d" name="DateOfBirth" tabindex="-1">
                  <option value="" disabled="">Día...</option>
                  <option value="01">1</option>
                  <option value="02">2</option>
                  <option value="03">3</option>
                  <option value="04">4</option>
                  <option value="05">5</option>
                  <option value="06">6</option>
                  <option value="07">7</option>
                  <option value="08">8</option>
                  <option value="09">9</option>
                  <option value="10">10</option>
                  <option value="11">11</option>
                  <option value="12">12</option>
                  <option value="13">13</option>
                  <option value="14">14</option>
                  <option value="15">15</option>
                  <option value="16">16</option>
                  <option value="17">17</option>
                  <option value="18">18</option>
                  <option value="19">19</option>
                  <option value="20">20</option>
                  <option value="21">21</option>
                  <option value="22">22</option>
                  <option value="23">23</option>
                  <option value="24">24</option>
                  <option value="25">25</option>
                  <option value="26">26</option>
                  <option value="27">27</option>
                  <option value="28">28</option>
                  <option value="29">29</option>
                  <option value="30">30</option>
                  <option value="31">31</option>
                </select></div>
              <div class="selectric"><span class="label">Día...</span><b class="button">▾</b></div>
              <div class="selectric-items" tabindex="-1">
                <div class="selectric-scroll">
                  <ul>
                    <li data-index="0" class="disabled selected">Día...</li>
                    <li data-index="1" class="">1</li>
                    <li data-index="2" class="">2</li>
                    <li data-index="3" class="">3</li>
                    <li data-index="4" class="">4</li>
                    <li data-index="5" class="">5</li>
                    <li data-index="6" class="">6</li>
                    <li data-index="7" class="">7</li>
                    <li data-index="8" class="">8</li>
                    <li data-index="9" class="">9</li>
                    <li data-index="10" class="">10</li>
                    <li data-index="11" class="">11</li>
                    <li data-index="12" class="">12</li>
                    <li data-index="13" class="">13</li>
                    <li data-index="14" class="">14</li>
                    <li data-index="15" class="">15</li>
                    <li data-index="16" class="">16</li>
                    <li data-index="17" class="">17</li>
                    <li data-index="18" class="">18</li>
                    <li data-index="19" class="">19</li>
                    <li data-index="20" class="">20</li>
                    <li data-index="21" class="">21</li>
                    <li data-index="22" class="">22</li>
                    <li data-index="23" class="">23</li>
                    <li data-index="24" class="">24</li>
                    <li data-index="25" class="">25</li>
                    <li data-index="26" class="">26</li>
                    <li data-index="27" class="">27</li>
                    <li data-index="28" class="">28</li>
                    <li data-index="29" class="">29</li>
                    <li data-index="30" class="">30</li>
                    <li data-index="31" class="last">31</li>
                  </ul>
                </div>
              </div><input class="selectric-input" tabindex="0">
            </div>
          </div>
          <div class="third" id="DateOfBirth_MonthList">
            <div class="selectric-wrapper selectric-_month selectric-mp-no-track">
              <div class="selectric-hide-select"><select class="_month mp-no-track" id="DateOfBirth_m" name="DateOfBirth.Month" tabindex="-1">
                  <option value="" disabled="">Mes...</option>
                  <option value="01">enero</option>
                  <option value="02">febrero</option>
                  <option value="03">marzo</option>
                  <option value="04">abril</option>
                  <option value="05">mayo</option>
                  <option value="06">junio</option>
                  <option value="07">julio</option>
                  <option value="08">agosto</option>
                  <option value="09">septiembre</option>
                  <option value="10">octubre</option>
                  <option value="11">noviembre</option>
                  <option value="12">diciembre</option>
                </select></div>
              <div class="selectric"><span class="label">Mes...</span><b class="button">▾</b></div>
              <div class="selectric-items" tabindex="-1">
                <div class="selectric-scroll">
                  <ul>
                    <li data-index="0" class="disabled selected">Mes...</li>
                    <li data-index="1" class="">enero</li>
                    <li data-index="2" class="">febrero</li>
                    <li data-index="3" class="">marzo</li>
                    <li data-index="4" class="">abril</li>
                    <li data-index="5" class="">mayo</li>
                    <li data-index="6" class="">junio</li>
                    <li data-index="7" class="">julio</li>
                    <li data-index="8" class="">agosto</li>
                    <li data-index="9" class="">septiembre</li>
                    <li data-index="10" class="">octubre</li>
                    <li data-index="11" class="">noviembre</li>
                    <li data-index="12" class="last">diciembre</li>
                  </ul>
                </div>
              </div><input class="selectric-input" tabindex="0">
            </div>
          </div>
          <div class="third" id="DateOfBirth_YearList">
            <div class="selectric-wrapper selectric-_year selectric-mp-no-track">
              <div class="selectric-hide-select"><select class="_year mp-no-track" id="DateOfBirth_y" name="DateOfBirth.Year" tabindex="-1">
                  <option value="" disabled="">Año...</option>
                  <option value="2024" disabled="disabled">2024</option>
                  <option value="2023" disabled="disabled">2023</option>
                  <option value="2022" disabled="disabled">2022</option>
                  <option value="2021" disabled="disabled">2021</option>
                  <option value="2020" disabled="disabled">2020</option>
                  <option value="2019" disabled="disabled">2019</option>
                  <option value="2018" disabled="disabled">2018</option>
                  <option value="2017" disabled="disabled">2017</option>
                  <option value="2016" disabled="disabled">2016</option>
                  <option value="2015" disabled="disabled">2015</option>
                  <option value="2014" disabled="disabled">2014</option>
                  <option value="2013" disabled="disabled">2013</option>
                  <option value="2012" disabled="disabled">2012</option>
                  <option value="2011" disabled="disabled">2011</option>
                  <option value="2010" disabled="disabled">2010</option>
                  <option value="2009" disabled="disabled">2009</option>
                  <option value="2008" disabled="disabled">2008</option>
                  <option value="2007" disabled="disabled">2007</option>
                  <option value="2006">2006</option>
                  <option value="2005">2005</option>
                  <option value="2004">2004</option>
                  <option value="2003">2003</option>
                  <option value="2002">2002</option>
                  <option value="2001">2001</option>
                  <option value="2000">2000</option>
                  <option value="1999">1999</option>
                  <option value="1998">1998</option>
                  <option value="1997">1997</option>
                  <option value="1996">1996</option>
                  <option value="1995">1995</option>
                  <option value="1994">1994</option>
                  <option value="1993">1993</option>
                  <option value="1992">1992</option>
                  <option value="1991">1991</option>
                  <option value="1990">1990</option>
                  <option value="1989">1989</option>
                  <option value="1988">1988</option>
                  <option value="1987">1987</option>
                  <option value="1986">1986</option>
                  <option value="1985">1985</option>
                  <option value="1984">1984</option>
                  <option value="1983">1983</option>
                  <option value="1982">1982</option>
                  <option value="1981">1981</option>
                  <option value="1980">1980</option>
                  <option value="1979">1979</option>
                  <option value="1978">1978</option>
                  <option value="1977">1977</option>
                  <option value="1976">1976</option>
                  <option value="1975">1975</option>
                  <option value="1974">1974</option>
                  <option value="1973">1973</option>
                  <option value="1972">1972</option>
                  <option value="1971">1971</option>
                  <option value="1970">1970</option>
                  <option value="1969">1969</option>
                  <option value="1968">1968</option>
                  <option value="1967">1967</option>
                  <option value="1966">1966</option>
                  <option value="1965">1965</option>
                  <option value="1964">1964</option>
                  <option value="1963">1963</option>
                  <option value="1962">1962</option>
                  <option value="1961">1961</option>
                  <option value="1960">1960</option>
                  <option value="1959">1959</option>
                  <option value="1958">1958</option>
                  <option value="1957">1957</option>
                  <option value="1956">1956</option>
                  <option value="1955">1955</option>
                  <option value="1954">1954</option>
                  <option value="1953">1953</option>
                  <option value="1952">1952</option>
                  <option value="1951">1951</option>
                  <option value="1950">1950</option>
                  <option value="1949">1949</option>
                  <option value="1948">1948</option>
                  <option value="1947">1947</option>
                  <option value="1946">1946</option>
                  <option value="1945">1945</option>
                  <option value="1944">1944</option>
                  <option value="1943">1943</option>
                  <option value="1942">1942</option>
                  <option value="1941">1941</option>
                  <option value="1940">1940</option>
                  <option value="1939">1939</option>
                  <option value="1938">1938</option>
                  <option value="1937">1937</option>
                  <option value="1936">1936</option>
                  <option value="1935">1935</option>
                  <option value="1934">1934</option>
                  <option value="1933">1933</option>
                  <option value="1932">1932</option>
                  <option value="1931">1931</option>
                  <option value="1930">1930</option>
                  <option value="1929">1929</option>
                  <option value="1928">1928</option>
                  <option value="1927">1927</option>
                  <option value="1926">1926</option>
                  <option value="1925">1925</option>
                  <option value="1924">1924</option>
                  <option value="1923">1923</option>
                  <option value="1922">1922</option>
                  <option value="1921">1921</option>
                  <option value="1920">1920</option>
                  <option value="1919">1919</option>
                  <option value="1918">1918</option>
                  <option value="1917">1917</option>
                  <option value="1916">1916</option>
                  <option value="1915">1915</option>
                  <option value="1914">1914</option>
                  <option value="1913">1913</option>
                  <option value="1912">1912</option>
                  <option value="1911">1911</option>
                  <option value="1910">1910</option>
                  <option value="1909">1909</option>
                  <option value="1908">1908</option>
                  <option value="1907">1907</option>
                  <option value="1906">1906</option>
                  <option value="1905">1905</option>
                  <option value="1904">1904</option>
                  <option value="1903">1903</option>
                  <option value="1902">1902</option>
                  <option value="1901">1901</option>
                  <option value="1900">1900</option>
                </select></div>
              <div class="selectric"><span class="label">Año...</span><b class="button">▾</b></div>
              <div class="selectric-items" tabindex="-1">
                <div class="selectric-scroll">
                  <ul>
                    <li data-index="0" class="disabled selected">Año...</li>
                    <li data-index="1" class="disabled">2024</li>
                    <li data-index="2" class="disabled">2023</li>
                    <li data-index="3" class="disabled">2022</li>
                    <li data-index="4" class="disabled">2021</li>
                    <li data-index="5" class="disabled">2020</li>
                    <li data-index="6" class="disabled">2019</li>
                    <li data-index="7" class="disabled">2018</li>
                    <li data-index="8" class="disabled">2017</li>
                    <li data-index="9" class="disabled">2016</li>
                    <li data-index="10" class="disabled">2015</li>
                    <li data-index="11" class="disabled">2014</li>
                    <li data-index="12" class="disabled">2013</li>
                    <li data-index="13" class="disabled">2012</li>
                    <li data-index="14" class="disabled">2011</li>
                    <li data-index="15" class="disabled">2010</li>
                    <li data-index="16" class="disabled">2009</li>
                    <li data-index="17" class="disabled">2008</li>
                    <li data-index="18" class="disabled">2007</li>
                    <li data-index="19" class="">2006</li>
                    <li data-index="20" class="">2005</li>
                    <li data-index="21" class="">2004</li>
                    <li data-index="22" class="">2003</li>
                    <li data-index="23" class="">2002</li>
                    <li data-index="24" class="">2001</li>
                    <li data-index="25" class="">2000</li>
                    <li data-index="26" class="">1999</li>
                    <li data-index="27" class="">1998</li>
                    <li data-index="28" class="">1997</li>
                    <li data-index="29" class="">1996</li>
                    <li data-index="30" class="">1995</li>
                    <li data-index="31" class="">1994</li>
                    <li data-index="32" class="">1993</li>
                    <li data-index="33" class="">1992</li>
                    <li data-index="34" class="">1991</li>
                    <li data-index="35" class="">1990</li>
                    <li data-index="36" class="">1989</li>
                    <li data-index="37" class="">1988</li>
                    <li data-index="38" class="">1987</li>
                    <li data-index="39" class="">1986</li>
                    <li data-index="40" class="">1985</li>
                    <li data-index="41" class="">1984</li>
                    <li data-index="42" class="">1983</li>
                    <li data-index="43" class="">1982</li>
                    <li data-index="44" class="">1981</li>
                    <li data-index="45" class="">1980</li>
                    <li data-index="46" class="">1979</li>
                    <li data-index="47" class="">1978</li>
                    <li data-index="48" class="">1977</li>
                    <li data-index="49" class="">1976</li>
                    <li data-index="50" class="">1975</li>
                    <li data-index="51" class="">1974</li>
                    <li data-index="52" class="">1973</li>
                    <li data-index="53" class="">1972</li>
                    <li data-index="54" class="">1971</li>
                    <li data-index="55" class="">1970</li>
                    <li data-index="56" class="">1969</li>
                    <li data-index="57" class="">1968</li>
                    <li data-index="58" class="">1967</li>
                    <li data-index="59" class="">1966</li>
                    <li data-index="60" class="">1965</li>
                    <li data-index="61" class="">1964</li>
                    <li data-index="62" class="">1963</li>
                    <li data-index="63" class="">1962</li>
                    <li data-index="64" class="">1961</li>
                    <li data-index="65" class="">1960</li>
                    <li data-index="66" class="">1959</li>
                    <li data-index="67" class="">1958</li>
                    <li data-index="68" class="">1957</li>
                    <li data-index="69" class="">1956</li>
                    <li data-index="70" class="">1955</li>
                    <li data-index="71" class="">1954</li>
                    <li data-index="72" class="">1953</li>
                    <li data-index="73" class="">1952</li>
                    <li data-index="74" class="">1951</li>
                    <li data-index="75" class="">1950</li>
                    <li data-index="76" class="">1949</li>
                    <li data-index="77" class="">1948</li>
                    <li data-index="78" class="">1947</li>
                    <li data-index="79" class="">1946</li>
                    <li data-index="80" class="">1945</li>
                    <li data-index="81" class="">1944</li>
                    <li data-index="82" class="">1943</li>
                    <li data-index="83" class="">1942</li>
                    <li data-index="84" class="">1941</li>
                    <li data-index="85" class="">1940</li>
                    <li data-index="86" class="">1939</li>
                    <li data-index="87" class="">1938</li>
                    <li data-index="88" class="">1937</li>
                    <li data-index="89" class="">1936</li>
                    <li data-index="90" class="">1935</li>
                    <li data-index="91" class="">1934</li>
                    <li data-index="92" class="">1933</li>
                    <li data-index="93" class="">1932</li>
                    <li data-index="94" class="">1931</li>
                    <li data-index="95" class="">1930</li>
                    <li data-index="96" class="">1929</li>
                    <li data-index="97" class="">1928</li>
                    <li data-index="98" class="">1927</li>
                    <li data-index="99" class="">1926</li>
                    <li data-index="100" class="">1925</li>
                    <li data-index="101" class="">1924</li>
                    <li data-index="102" class="">1923</li>
                    <li data-index="103" class="">1922</li>
                    <li data-index="104" class="">1921</li>
                    <li data-index="105" class="">1920</li>
                    <li data-index="106" class="">1919</li>
                    <li data-index="107" class="">1918</li>
                    <li data-index="108" class="">1917</li>
                    <li data-index="109" class="">1916</li>
                    <li data-index="110" class="">1915</li>
                    <li data-index="111" class="">1914</li>
                    <li data-index="112" class="">1913</li>
                    <li data-index="113" class="">1912</li>
                    <li data-index="114" class="">1911</li>
                    <li data-index="115" class="">1910</li>
                    <li data-index="116" class="">1909</li>
                    <li data-index="117" class="">1908</li>
                    <li data-index="118" class="">1907</li>
                    <li data-index="119" class="">1906</li>
                    <li data-index="120" class="">1905</li>
                    <li data-index="121" class="">1904</li>
                    <li data-index="122" class="">1903</li>
                    <li data-index="123" class="">1902</li>
                    <li data-index="124" class="">1901</li>
                    <li data-index="125" class="last">1900</li>
                  </ul>
                </div>
              </div><input class="selectric-input" tabindex="0">
            </div>
          </div>
        </div>
      </div>
      <span class="error-text bottom-text">
        <span class="field-validation-valid" data-valmsg-for="DateOfBirth" data-valmsg-replace="true"></span>
      </span>
    </fieldset>
    <fieldset class="form-row">
      <div class="label-wrap">
        <label class="bolded" for="ActivationCode">Activation code</label>
      </div>
      <div class="long">
        <input class="in-text capitalize disabled mp-no-track" data-val="true" data-val-maxlength="Activation Code maximum input length is 30 characters" data-val-maxlength-max="30" data-val-required="Activation code is required" id="ActivationCode"
          maxlength="100" name="ActivationCode" placeholder="Enter activation code..." readonly="readonly" type="text" value="6558548E">
      </div>
      <span class="error-text bottom-text">
        <span class="field-validation-valid" data-valmsg-for="ActivationCode" data-valmsg-replace="true"></span>
      </span>
    </fieldset>
    <fieldset class="form-row">
      <div class="label-wrap">
        <label class="bolded" for="Email">Correo electrónico</label>
      </div>
      <div class="long">
        <input class="in-text mp-no-track" data-val="true" data-val-email="La dirección de correo electrónico no es una dirección de correo electrónico válida."
          data-val-maxlength="La longitud máxima de entrada de correo electrónico es de 100 caracteres" data-val-maxlength-max="100" data-val-required="Correo electronico es requerido" id="Email" maxlength="100" name="Email"
          placeholder="Introducir la dirección de correo electrónico..." type="text" value="">
      </div>
      <span class="bottom-text">Su dirección de correo electrónico se usará como su ID de inicio de sesión. No puede editar esta dirección de correo electrónico.</span>
      <span class="error-text bottom-text">
        <span class="field-validation-valid" data-valmsg-for="Email" data-valmsg-replace="true"></span>
      </span>
    </fieldset>
    <fieldset class="form-row">
      <div class="label-wrap">
        <label class="bolded" for="ConfirmEmail">Confirmar el correo electrónico</label>
      </div>
      <div class="long">
        <input class="in-text mp-no-track" data-val="true" data-val-equalto="El correo electrónico y el correo electrónico de confirmación deben coincidir" data-val-equalto-other="Email"
          data-val-required="Confirmar que se requiere correo electrónico" id="ConfirmEmail" maxlength="100" name="ConfirmEmail" placeholder="Introduzca de nuevo el correo electrónico ..." type="text" value="">
      </div>
      <span class="error-text bottom-text">
        <span class="field-validation-valid" data-valmsg-for="ConfirmEmail" data-valmsg-replace="true"></span>
      </span>
    </fieldset>
    <fieldset class="form-row">
      <div class="label-wrap">
        <label class="bolded" for="Password">Contraseña</label>
      </div>
      <div class="long password-container">
        <input class="in-text mp-no-track" data-val="false" data-val-maxlength="La longitud máxima de entrada de la contraseña es de 100 caracteres" data-val-maxlength-max="100" data-val-required="Se requiere contraseña"
          data-val-unifiedpasswordvalidation="The field Contraseña is invalid." data-val-unifiedpasswordvalidation-clientvalidationmethods="mustsatisfyminimallength;;mustcontaindigits;;mustcontainlowercase;;mustcontainuppercase;;mustcontainsymbols"
          data-val-unifiedpasswordvalidation-errormessages="La contraseña debe tener al menos 8 caracteres;;La contraseña debe contener al menos un dígito;;La contraseña debe contener al menos un carácter de;;La contraseña debe contener al menos un carácter en mayúscula;;La contraseña debe contener al menos un símbolo"
          data-val-unifiedpasswordvalidation-validationparameters="{&quot;minlength&quot;:8};;{};;{};;{};;{}" id="Password" maxlength="100" name="Password" placeholder="Introducir la contraseña..." type="password">
        <a href="javascript:;" class="eye-icons" data-action="show-password">
    <i class="icon icon-eye" aria-hidden="true"></i>
    <i class="icon icon-eye-cross-out" aria-hidden="true"></i>
</a>
      </div>
      <span class="error-text bottom-text">
        <span class="field-validation-valid" data-valmsg-for="Password" data-valmsg-replace="true"></span>
      </span>
    </fieldset>
    <fieldset class="form-row">
      <legend></legend>
      <div class="label-wrap">
        <label class="bolded" for="ConfirmPassword">Confirmar contraseña</label>
      </div>
      <div class="long password-container">
        <input class="in-text mp-no-track" data-val="false" data-val-equalto="Confirmar contraseña y contraseña no coinciden" data-val-equalto-other="Password" data-val-requiredif="Confirmar contraseña es obligatoria"
          data-val-requiredif-dependentproperty="IsConfirmPasswordRequiredOnAccountInformation" data-val-requiredif-desiredvalue="True" id="ConfirmPassword" maxlength="100" name="ConfirmPassword" placeholder="Ingrese de nuevo la contraseña..."
          type="password">
        <a href="javascript:;" class="eye-icons" data-action="show-password">
    <i class="icon icon-eye" aria-hidden="true"></i>
    <i class="icon icon-eye-cross-out" aria-hidden="true"></i>
</a>
        <div id="validationConditions" class="validation-conditions">
          <ul class="half">
            <li id="hasLowerCase">
              <i class="icon icon-full-circle" aria-hidden="true"></i>
              <i class="icon icon-check" aria-hidden="true"></i>
              <span class="small-text condition">One lowercase character</span>
            </li>
            <li id="hasUpperCase">
              <i class="icon icon-full-circle" aria-hidden="true"></i>
              <i class="icon icon-check" aria-hidden="true"></i>
              <span class="small-text condition">One uppercase character</span>
            </li>
            <li id="hasDigit">
              <i class="icon icon-full-circle" aria-hidden="true"></i>
              <i class="icon icon-check" aria-hidden="true"></i>
              <span class="small-text condition">One number</span>
            </li>
          </ul>
          <ul class="half">
            <li id="hasSpecialCharacter">
              <i class="icon icon-full-circle" aria-hidden="true"></i>
              <i class="icon icon-check" aria-hidden="true"></i>
              <span class="small-text condition">One special character</span>
            </li>
            <li id="isMinLengthSatisfied">
              <i class="icon icon-full-circle" aria-hidden="true"></i>
              <i class="icon icon-check" aria-hidden="true"></i>
              <span class="small-text condition">8 characters minimum</span>
            </li>
            <li id="passwordMatch">
              <i class="icon icon-full-circle" aria-hidden="true"></i>
              <i class="icon icon-check" aria-hidden="true"></i>
              <span class="small-text condition">Passwords must match</span>
            </li>
          </ul>
        </div>
      </div>
      <span class="error-text bottom-text">
        <span class="field-validation-valid" data-valmsg-for="ConfirmPassword" data-valmsg-replace="true"></span>
      </span>
    </fieldset>
    <div class="grey-bg grey-block full-width mb10">
      <h5>Terms and conditions</h5>
      <div class="form-row blue-links">
        <div class="full-width mt9">
          <div class="custom-checkbox white-bg ">
            <input class="i-agree-checkbox always-validate" data-val="true" data-val-mandatorycheckbox="Términos y condiciones deben ser aceptados" id="TermsAndConditions" name="TermsAndConditions" type="checkbox" value="true"><input
              name="TermsAndConditions" type="hidden" value="false">
            <label for="TermsAndConditions">
              <i class="state"></i>
              <span>
                <p>I agree to the <a title="terms and conditions" href="https://doctorcareanywhere.com/terms-and-conditions/" target="_blank" rel="noopener">terms and conditions</a> and
                  <a title="privacy policy" href="https://doctorcareanywhere.com/privacy-policy/" target="_blank" rel="noopener">privacy policy</a></p>
              </span>
            </label>
          </div>
        </div>
        <span class="error-text bottom-text">
          <span class="field-validation-valid" data-valmsg-for="TermsAndConditions" data-valmsg-replace="true" style="color: red"></span>
        </span>
      </div>
    </div>
    <div class="grey-bg grey-block full-width contact-permission">
      <p class="mb20"> Now and then, we'd like to send you exclusive offers, discounts and rewards relevant to you. Choose how you'd like to receive these. Whatever you decide, we'll continue to send you important messages about your account. </p>
      <div class="yes-no-list flex-direction-row-sm-col space-between">
        <div class="inline-elements">
          <div class="label-wrap">
            <label class="bolded">Contact via email</label>
          </div>
          <div class="inline-elements narrow-label-wrap">
            <div class="choose narrow-label white-green">
              <input name="ContactPermissions.ContactMeViaEmail" class="option" data-val="true" data-val-required="The ContactMeViaEmail field is required." id="ContactMeViaEmail_Yes" type="radio" value="Yes">
              <label for="ContactMeViaEmail_Yes"> Yes <i class="icon-check" aria-hidden="true"></i>
              </label>
            </div>
            <div class="choose narrow-label white-green">
              <input name="ContactPermissions.ContactMeViaEmail" class="option" id="ContactMeViaEmail_No" type="radio" value="No">
              <label for="ContactMeViaEmail_No"> No <i class="icon-x" aria-hidden="true"></i>
              </label>
            </div>
          </div>
        </div>
        <div class="inline-elements">
          <div class="label-wrap">
            <label class="bolded">Contact via SMS</label>
          </div>
          <div class="inline-elements narrow-label-wrap">
            <div class="choose narrow-label white-green">
              <input name="ContactPermissions.ContactMeViaSms" class="option" data-val="true" data-val-required="The ContactMeViaSms field is required." id="ContactMeViaSMS_Yes" type="radio" value="Yes">
              <label for="ContactMeViaSMS_Yes"> Yes <i class="icon-check" aria-hidden="true"></i>
              </label>
            </div>
            <div class="choose narrow-label white-green">
              <input name="ContactPermissions.ContactMeViaSms" class="option" id="ContactMeViaSMS_No" type="radio" value="No">
              <label for="ContactMeViaSMS_No"> No <i class="icon-x" aria-hidden="true"></i>
              </label>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="left-col-inner horizontal-align no-action no-padding">
    <span id="processingMessage" class="hidden">We are processing your submission. We kindly request your patience as we validate your request.</span>
  </div>
  <div id="submitWrapper" class="left-col-inner horizontal-align no-action">
    <span class="no-action-overlay"></span>
    <input id="accountInformationSubmit" type="submit" class="btn btn-50 btn-arrow disabled" disabled="disabled" value="Firma completa">
  </div>
</form>

Text Content

Please be aware that we will be performing planned server improvements from
21:00 on Thursday, 19th September, until 04:00 the following morning. During
this time, the Doctor Care Anywhere service will be unavailable. We apologise
for the inconvenience and appreciate your patience.

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otro navegador, como Google Chrome

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RESUMEN DEL PLAN

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TUS DETALLES

Nombre

Apellidos

Fecha de nacimiento
Día...12345678910111213141516171819202122232425262728293031
Día...▾
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Año...20242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900
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Activation code

Correo electrónico

Su dirección de correo electrónico se usará como su ID de inicio de sesión. No
puede editar esta dirección de correo electrónico.
Confirmar el correo electrónico

Contraseña

Confirmar contraseña
 * One lowercase character
 * One uppercase character
 * One number

 * One special character
 * 8 characters minimum
 * Passwords must match

TERMS AND CONDITIONS

I agree to the terms and conditions and privacy policy

Now and then, we'd like to send you exclusive offers, discounts and rewards
relevant to you. Choose how you'd like to receive these. Whatever you decide,
we'll continue to send you important messages about your account.

Contact via email
Yes
No
Contact via SMS
Yes
No
We are processing your submission. We kindly request your patience as we
validate your request.




RESUMEN DEL PLAN

Your new plan is nearly set up. We just need some further details to verify you.
Complete the sign-up page and click the submit button.


TU INFORMACIÓN

Los detalles que proporcione se utilizarán para activar su cuenta, crear su
registro digital de atención médica y ayudarnos a brindar una experiencia de
atención médica segura para mantener y mejorar su salud.

Cuando se trata de proteger sus datos, nos aferramos a los más altos estándares
y lo tratamos con respeto. Puedes encontrar detalles en nuestro términos y
Condiciones y política de privacidad.



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