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Form analysis
3 forms found in the DOM

<form id="sign-in-form"><input type="hidden" name="loc" value="hsceye"> <span>
    <div class="animated">
      <div class="input-group"><label class=""><span style="font-weight: bold;"> 9-Digit Manitoba PHIN </span> <br> <span style="font-size: 9pt;">If not from Manitoba, use your provincial health number</span> <input name="phin" id="phin"
            autofocus="autofocus" required="required" class="form-control"> <span style="cursor: pointer;"><span style="font-size: 9pt;">What is my PHIN or provincial health number?</span> <span class="glyphicons glyphicons-question-sign"
              style="font-size: 9pt; vertical-align: middle;"></span></span></label></div>
      <div class="input-group" style="margin-top: 10px;"><label class="" style="font-weight: bold;"> Date of Birth </label>
        <div class="dob-wrapper"><select id="month" required="required" class="form-control">
            <option value="">Month</option>
            <option value="01">January</option>
            <option value="02">February</option>
            <option value="03">March</option>
            <option value="04">April</option>
            <option value="05">May</option>
            <option value="06">June</option>
            <option value="07">July</option>
            <option value="08">August</option>
            <option value="09">September</option>
            <option value="10">October</option>
            <option value="11">November</option>
            <option value="12">December</option>
          </select> <input name="day" id="day" placeholder="dd" required="required" class="form-control" maxlength="2"> <input name="year" id="year" placeholder="yyyy" required="required" class="form-control" maxlength="4"></div>
      </div> <button type="button" class="portal-btn continue"> Continue </button>
    </div>
  </span></form>

<form class="message-form"><!---->
  <div class="message-editor">
    <div class="message-inputs"><input type="file" disabled="disabled" accept="image/jpg,image/jpeg,image/png,image/gif,application/pdf" multiple="multiple"> <textarea id="newMessage" readonly="readonly"></textarea></div> <button type="submit"
      disabled="disabled" class="portal-btn">Send</button>
  </div>
</form>

POST viewAttachment.php

<form id="render-form" action="viewAttachment.php" target="_blank" method="post"><textarea name="encoded"></textarea> <input name="mime"> <input name="title"> <input name="filename"></form>

Text Content

HSC Children's Eye Clinic
To view your message, please verify your identity:

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9-Digit Manitoba PHIN
If not from Manitoba, use your provincial health number What is my PHIN or
provincial health number?
Date of Birth
Month January February March April May June July August September October
November December
Continue

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For assistance, contact HSC Children's Eye Clinic at 204-787-8500
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