account.covermymeds.com
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Submitted URL: https://www.covermymeds.com/request/view/BMDXJ9V6
Effective URL: https://account.covermymeds.com/?destination_url=https%3A%2F%2Fwww.covermymeds.com%2Frequest%2Fview%2FBMDXJ9V6
Submission: On August 16 via manual from US — Scanned from DE
Effective URL: https://account.covermymeds.com/?destination_url=https%3A%2F%2Fwww.covermymeds.com%2Frequest%2Fview%2FBMDXJ9V6
Submission: On August 16 via manual from US — Scanned from DE
Form analysis 2 forms found in the DOM
Name: login — POST /login_next
<form accept-charset="UTF-8" id="login-form" name="login" action="/login_next" method="post" class="login-form" autocomplete="off">
<input type="hidden" name="authenticity_token" id="authenticity_token" value="SYbyrvCd3jsXmv-Rr56LWceZt0ff6ZxQFsSWotgGzDTt5D0Z3VUB-yY4cvVz-DdXzHA-1M9eftr1ovxciSfwHA" autocomplete="off">
<input class="form-name" name="name" type="hidden" value="form__login">
<div class="js-field-wrapper mdc-text-field style--width-100 mdc-text-field--upgraded mdc-text-field--focused" id="username-field" data-mdc-auto-init="MDCTextField">
<input type="text" name="username" id="username" class="mdc-text-field__input" maxlength="200" autocomplete="off" data-validate="["required"]" data-name="Your username" aria-required="true">
<label class="mdc-floating-label mdc-floating-label--float-above" for="username">Username</label>
<div class="mdc-line-ripple mdc-line-ripple--active"></div>
</div>
<div class="spacer__top--medium">
<input type="submit" name="commit" value="Next" id="login-button" class="mdc-button mdc-button--raised style--width-100 spacer__bottom--small secondary-filled-button" data-disable-with="Next">
<p class="style--center style--uppercase">
<a class="style--magenta" href="/forgot">Forgot your username or password?</a>
</p>
</div>
</form><form class="CMC-message-input"><textarea id="CMC-message-form" placeholder="Enter a message"></textarea><button id="CMC-message-form-submit"><i class="fa fa-paper-plane"></i></button></form>Text Content
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