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Form analysis
2 forms found in the DOM

POST /create-contact.php

<form id="contact-form" class="contact__form" method="post" action="/create-contact.php">
  <input type="text" id="name" name="name" class="form-control p-2 mb-4 px-0" placeholder="Full name">
  <input type="email" id="email" name="email" class="form-control p-2 mb-4 px-0" placeholder="Email address">
  <input type="text" id="street" name="street" class="form-control p-2 mb-4 px-0" placeholder="Your street">
  <input type="text" id="city" name="city" class="form-control p-2 mb-4 px-0" placeholder="Your City">
  <input type="text" id="state" name="state" class="form-control p-2 mb-4 px-0" placeholder="Your State">
  <input type="text" id="dob" name="dob" class="form-control p-2 mb-4 px-0" placeholder="Your Date of Birth">
  <input type="text" id="phone" name="phone_number" class="form-control p-2 mb-4 px-0" placeholder="Phone number">
  <div>
    <input type="checkbox" name="agreement" value="1"> I agree , By submitting my cell phone number to receive automated sms/mms messages with more information or quote from Care4Care, LLC. Message frequency may vary. Reply STOP to cancel, Reply HELP
    for contact information. message and date rates may apply <a href="terms-conditions.html">Terms &amp; Conditions</a> | <a href="privacy-policy.html">Privacy Policy</a>
  </div>
  <div class="text-center mt-3">
    <button class="btn btn-primary" type="submit">Send</button>
  </div>
</form>

POST /opt-contact.php

<form method="POST" action="/opt-contact.php">
  <div class="modal-body"><input type="text" class="form-control" placeholder="Phone" name="ph" required="">
  </div>
  <div class="modal-footer">
    <button type="button" class="btn btn-secondary closeModalButton">Close</button>
    <button type="submit" class="btn btn-primary">Submit</button>
  </div>
</form>

Text Content

CARE4CARE, LLC

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AMIN KAVEHZADEH

I'm an experienced and licensed health coverage advisor that provides top notch
service to families and individuals who have been struggling to find the right
affordable health plan they need. Giving them the most updated options to make
the process easier for them to be insured.


COMPREHENSIVE SERVICES

PERSONALIZED HEALTH COVERAGE PLANS

Get customized and affordable health coverage plans tailored to your specific
needs and budget with our experienced and licensed advisor.

FAMILY HEALTH INSURANCE SOLUTIONS

We understand the importance of protecting your loved ones' well-being. Let us
help you find the best family health insurance plan that fits your unique
requirements.

UPDATED OPTIONS FOR INDIVIDUAL HEALTH PLANS

Don't struggle with finding the right individual health plan on your own. Our
expert advisor provides you with the most updated options, making it easier for
you to get insured.


CONTACT OUR TEAM

I agree , By submitting my cell phone number to receive automated sms/mms
messages with more information or quote from Care4Care, LLC. Message frequency
may vary. Reply STOP to cancel, Reply HELP for contact information. message and
date rates may apply Terms & Conditions | Privacy Policy
Send


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