parexel.ambrahealth.com Open in urlscan Pro
198.102.255.22  Public Scan

Form analysis
2 forms found in the DOM

<form onsubmit="return createAccount(this)" class="form-horizontal">
  <div class="form-group">
    <div class="page-header col-sm-offset-2 col-sm-3">
      <h1 data-i18n-token="global:register"></h1>
      <a href="/" data-i18n-token="global:already-have-an-account">Already have an account?</a>
      <ul id="custom-docs" class="list-unstyled" style="padding-top: 15px;">
        <li><a href="http://www.perceptivepartnerprogram.com/files/4015/9342/6259/Ambra_eTransfer_Instructions.pdf" target="_blank"><font color="eight">eTransfer Instructions</font></a></li>
        <font color="eight">
          <li><a href="https://support.ambrahealth.com/" target="_blank"><font color="#006699">Need assistance? Click here for tutorials and support articles</font></a></li>
          <font color="#006699">
          </font>
        </font>
      </ul>
    </div>
  </div>
  <div class="form-group">
    <label class="col-sm-2 control-label required_before" data-i18n-token="global:first-name" data-symbol="*">First name</label>
    <div class="col-sm-3">
      <input data-validate="required" class="form-control" id="first" size="30" type="text" tabindex="1">
      <span class="help-inline"></span>
    </div>
  </div>
  <div class="form-group">
    <label class="col-sm-2 control-label required_before" data-i18n-token="global:last-name" data-symbol="*">Last name</label>
    <div class="col-sm-3">
      <input data-validate="required" class="form-control" id="last" size="30" type="text" tabindex="2">
      <span class="help-inline"></span>
    </div>
  </div>
  <div class="form-group">
    <label class="col-sm-2 control-label required_before" data-i18n-token="global:email-address" data-symbol="*">Email Address</label>
    <div class="col-sm-3">
      <input data-validate="required email" class="form-control" id="email" size="30" type="text" tabindex="3">
      <span class="help-inline"></span>
      <div class="duplicate-email"></div>
    </div>
  </div>
  <div class="form-group">
    <label class="col-sm-2 control-label required_before" data-i18n-token="global:password" data-symbol="*">Password</label>
    <div class="col-sm-3">
      <input data-validate="required" type="password" autocomplete="off" id="password" class="form-control" size="30" tabindex="4">
      <span class="help-inline"></span>
    </div>
  </div>
  <div class="form-group">
    <label class="col-sm-2 control-label required_before" data-i18n-token="global:confirm-password" data-symbol="*">Confirm password</label>
    <div class="col-sm-3">
      <input data-validate="required" type="password" autocomplete="off" id="password_confirm" class="form-control" size="30" tabindex="5">
      <span class="help-inline"></span>
      <div id="password-requirement-wrapper">
        <span class="help-block" data-i18n-token="global:eight-chars-longer"> 8 characters or longer, containing 2 numbers and 2 letters </span>
      </div>
    </div>
  </div>
  <div class="form-group" style="display:none">
    <label class="col-sm-2"></label>
    <div id="vanity-custom-fields-group" class="col-sm-3">
    </div>
  </div>
  <div class="form-group">
    <div id="accept-links" class="col-sm-offset-2 col-sm-5">
      <div id="terms-agreement-wrapper" class="agreement-wrapper">
        <div class="checkbox">
          <label class="checkbox__label">
            <input id="tos" value="1" tabindex="6" type="checkbox" data-validate="required">
            <span data-i18n-token="global:i-accept-the-masculine" class="checkbox__text required_before" data-symbol="*">I accept the</span>
            <a class="terms-page-link" href="/terms.html" target="_blank" data-i18n-token="global:terms-of-use">Terms of Use</a>
          </label>
        </div>
        <span class="help-inline"></span>
      </div>
      <div id="privacy-agreement-wrapper" class="agreement-wrapper">
        <div class="checkbox">
          <label class="checkbox__label">
            <input id="hip" value="1" tabindex="7" type="checkbox" data-validate="required">
            <span data-i18n-token="global:i-accept-the-feminine" class="checkbox__text required_before" data-symbol="*">I accept the</span>
            <a class="privacy-page-link" href="/privacy.html" target="_blank" data-i18n-token="global:privacy-policy">Privacy Policy</a>
          </label>
        </div>
        <span class="help-inline"></span>
      </div>
      <div id="indicator-agreement-wrapper" class="agreement-wrapper">
        <div class="checkbox">
          <label>
            <input id="ifu" value="1" tabindex="8" type="checkbox" data-validate="required">
            <span data-i18n-token="global:i-accept-the-feminine" class="checkbox__text required_before" data-symbol="*">I accept the</span>
            <a class="indications-page-link" href="/indications.html" target="_blank" data-i18n-token="global:indications-for-use">Indications for Use</a>
          </label>
        </div>
        <span class="help-inline"></span>
      </div>
    </div>
  </div>
  <div class="form-group">
    <div class="col-sm-offset-2 col-sm-3">
      <input type="submit" class="btn btn-primary" value="Register" data-i18n-value="global:join" tabindex="9">&nbsp; <button class="btn btn-default" data-i18n-token="global:cancel" data-dicomgrid-action-click="redirect-home"
        tabindex="10">Cancel</button>
    </div>
  </div>
</form>

<form id="page_status_form">
</form>

Text Content

 * Timepoints
 * Images
 * Activities
 * HL7
 * Patients
 * Analytics
 * Cases
 * Orders
 * Messages
 * Appointments
 * Sites
 * Queries
 * Research
 * Administration

 * Help
 * 
 * 
 * Sign Out




Already have an account?
 * eTransfer Instructions
   Need assistance? Click here for tutorials and support articles

First name

Last name

Email Address

Password

Confirm password
8 characters or longer, containing 2 numbers and 2 letters

I accept the Terms of Use
I accept the Privacy Policy
I accept the Indications for Use
  Cancel
 * Indications for Use
 * Terms of Use
 * Privacy Policy
 * 11-24-21 10:35:02 MST
   User name:
   User uuid:
   Account name:
   Account uuid:
   Page:
   Page load time: 2840ms
   Completed Actions
   /api/v3/terminology/list ( 792b, 48 records, 262ms)
   /api/v3/system/settings ( 221b, 265ms)
   Browser information
   Browser: Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML,
   like Gecko) Chrome/96.0.4664.45 Safari/537.36
   Connection: 4g 10Mbps
 * +AMBRHEALTHSOLUTIONS0/$$+7_V3.21.8.0 R
   
 * © 2021 DICOM Grid, Inc (dba Ambra Health)

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{{item}} saved.
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{{item}} deleted.
{{item}} removed.
{{item}} enabled.
Not allowed columns: {{#columns}}{{.}}{{/columns}}
Study for patient {{patient_name}} was sent to PACS {{pacs_name}}
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Modality {{ modality }} already has a price
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Patient Name DO NOT CHANGE Site Number DOB Accession # Study Description
Download to repository? Study Stage Send Status Destination name Study Date
Uploaded Date Starred Thin Modality Study UID Study UUID Tags {{#customfields}}
{{name}} {{/customfields}}