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www.myaffinityhealth.com Open in urlscan Pro
2a02:26f0:6c00::210:bb39  Public Scan

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URL: https://www.myaffinityhealth.com/
Submission: On February 27 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

Name: ContactUsForm — POST /Home/SendContactUsMail

<form action="/Home/SendContactUsMail" contactinfo="ASP._Page_Views_Shared__ContactUsForm_cshtml" data-ajax="true" data-ajax-failure="FailMail" data-ajax-method="POST" data-ajax-success="SuccessMail(data, status, xhr)" id="ContactUsForm"
  method="post" name="ContactUsForm" novalidate="novalidate">
  <div class="form-group">
    <label for="ContactForm_FirstName" class="hidden">First Name</label>
    <input autocomplete="given-name" class="form-control" data-val="true" data-val-length="The field First Name must be a string with a maximum length of 50." data-val-length-max="50" data-val-regex="First Name - Must only have letters."
      data-val-regex-pattern="^[a-zA-Z /'/-]{2,50}$" data-val-required="First Name - Required" id="ContactForm_FirstName" name="FirstName" placeholder="First Name" type="text" value="">
    <span class="field-validation-valid" data-valmsg-for="FirstName" data-valmsg-replace="true" style="color: red; font-weight: bold;"></span>
  </div>
  <div class="form-group">
    <label for="ContactForm_LastName" class="hidden">Last Name</label>
    <input autocomplete="family-name" class="form-control" data-val="true" data-val-length="The field Last Name must be a string with a maximum length of 100." data-val-length-max="100" data-val-regex="Last Name - Must only have letters."
      data-val-regex-pattern="^[a-zA-Z /'/-]{2,50}$" data-val-required="Last Name - Required" id="ContactForm_LastName" name="LastName" placeholder="Last Name" type="text" value="">
    <span class="field-validation-valid" data-valmsg-for="LastName" data-valmsg-replace="true" style="color: red; font-weight: bold;"></span>
  </div>
  <div class="form-group">
    <label for="ContactForm_DateOfBirth" class="hidden">Date of Birth</label>
    <input class="form-control date maskedField" data-val="true" data-val-date="The field Date of Birth must be a date." data-val-required="Date of Birth - Required" id="ContactForm_DateOfBirth" name="DateOfBirth"
      placeholder="Date of Birth (mm/dd/yyyy)" type="text" value="">
    <span class="field-validation-valid" data-valmsg-for="DateOfBirth" data-valmsg-replace="true" style="color: red; font-weight: bold;"></span>
  </div>
  <div class="form-group">
    <label for="ContactForm_Phone" class="hidden">Phone</label>
    <input autocomplete="tel-national" class="form-control phone maskedField" data-val="true" data-val-length="The field Phone must be a string with a maximum length of 16." data-val-length-max="16"
      data-val-maxlength="The field Phone must be a string or array type with a maximum length of '16'." data-val-maxlength-max="16" data-val-minlength="The field Phone must be a string or array type with a minimum length of '14'."
      data-val-minlength-min="14" data-val-regex="Phone - Must only have numbers." data-val-regex-pattern="^[0-9 /(/)/-]{14,16}$" data-val-required="Phone - Required" id="ContactForm_Phone" name="Phone" placeholder="Phone" type="text" value="">
    <span class="field-validation-valid" data-valmsg-for="Phone" data-valmsg-replace="true" style="color: red; font-weight: bold;"></span>
  </div>
  <div class="form-group">
    <label for="ContactForm_Email" class="hidden">Email address</label>
    <input autocomplete="email" class="form-control" data-val="true" data-val-maxlength="The field Email Address must be a string or array type with a maximum length of '40'." data-val-maxlength-max="40"
      data-val-regex="Email - Must be a valid e-mail address."
      data-val-regex-pattern="[A-Za-z0-9!#$%&amp;'*+/=?^_`{|}~-]+(?:\.[A-Za-z0-9!#$%&amp;'*+/=?^_`{|}~-]+)*@(?:[A-Za-z0-9](?:[A-Za-z0-9-]*[A-Za-z0-9])?\.)+[A-Za-z0-9](?:[A-Za-z0-9-]*[A-Za-z0-9])?" data-val-required="Email Address - Required"
      id="ContactForm_Email" name="EmailAddress" placeholder="Email" type="email" value="">
    <span class="field-validation-valid" data-valmsg-for="EmailAddress" data-valmsg-replace="true" style="color: red; font-weight: bold;"></span>
  </div>
  <div class="form-group">
    <label for="ContactForm_Message" class="hidden">Message</label>
    <textarea class="form-control" cols="20" data-val="true" data-val-length="The field Message must be a string with a maximum length of 400." data-val-length-max="400" data-val-required="Message - Required" id="ContactForm_Message" name="Message"
      placeholder="Message" rows="5"></textarea>
    <span class="field-validation-valid" data-valmsg-for="Message" data-valmsg-replace="true" style="color: red; font-weight: bold;"></span>
    <input data-val="true" data-val-length="The field hpcUserInquiry must be a string with a maximum length of 100." data-val-length-max="100" id="hpcUserInquiry" name="hpcUserInquiry" style="display:none;" type="text" value="">
    <input data-val="true" data-val-length="The field BeenRun must be a string with a maximum length of 1." data-val-length-max="1" id="BeenRun" name="BeenRun" type="hidden" value="">
  </div>
  <div class="login">
    <div class="generic-btn-flex-wrapper">
      <button type="button" class="blue-btn submit" id="btnSubmit" onclick="$(this).parents('form').submit();return false;">Submit</button>
    </div>
  </div>
</form>

Text Content

COVID-19 Updates & Vaccine Information

 * About Us
   * Overview
   * Awards & Recognitions
   * NCQA Recognition
   * Patient-Centered Medical Home
   * Case Management Clinics (CMCs)
   * Tobacco Cessation
   * Rate Us
   * Employment Opportunities
   * Affinity Blog
   * Feedback on Provider
   * Logos
   * Login to Schedule an Appointment
 * Patient Resources
   * Patient Portal
   * Pay Your Bill
   * Documents & Forms
   * Telemedicine
   * Chronic Disease & Wound Care
   * Frequently Asked Questions
 * Providers
 * Specialties
   * Behavioral Health
   * Cardiology
   * Dermatology
   * Diabetes Care
   * ENT & Audiology Services
     
     
   * Gynecology
   * Industrial Medicine
     
   * Internal Medicine
   * Nutrition
   * Occupational Therapy
   * Orthopedics
   * Pediatrics
   * Physical Therapy
   * Primary Care
     
   * Speech Therapy
   * Urology
   * Wellness
   * Wound Care
 * Locations
   * All Affinity Clinic Locations
   * Affinity Health Mgmt Ctr
   * Affinity ULM Clinic
   * 24/7 Walk-In Clinic
 * Pharmacies
   * Overview
   * Documents & Forms
   * Online Refills
   * Contact Us
 * Contact

MENU
 * CLOSE 
 * About Us 
   * Overview
   * Awards & Recognitions
   * NCQA Recognition
   * Patient-Centered Medical Home
   * Case Management Clinics (CMCs)
   * Tobacco Cessation
   * Rate Us
   * Employment Opportunities
   * Affinity Blog
   * Feedback on Provider
   * Login to Schedule an Appointment
 * Patient Resources 
   * Patient Portal
   * Pay Your Bill
   * Documents & Forms
   * Telemedicine
   * Chronic Disease & Wound Care
   * Frequently Asked Questions
 * Providers
 * Specialties 
   * Behavioral Health
   * Cardiology
   * Dermatology
   * Diabetes Care
   * ENT & Audiology Services
     
     
   * Gynecology
   * Industrial Medicine
     
   * Internal Medicine
   * Nutrition
   * Occupational Therapy
   * Orthopedics
   * Pediatrics
   * Physical Therapy
   * Primary Care
     
   * Speech Therapy
   * Urology
   * Wellness
   * Wound Care
 * Locations 
   * All Affinity Clinic Locations
   * Affinity Health Mgmt Ctr
   * Affinity ULM Clinic
   * 24/7 Walk-In Clinic
 * Pharmacies 
   * Overview
   * Documents & Forms
   * Online Refills
   * Contact Us
 * Industrial Medicine
 * Contact
   \


300 DeSiard Street, Monroe, LA 71201
(318) 807-7875 • TF: (866) 860-7510


AFFINITY HEALTH GROUP


IMPROVING LIVES,  
  IMPROVING CARE

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AFFINITY UPDATES CONCERNING COVID-19

Click to learn more


IT'S NEVER TOO LATE TO FIGHT THE FLU!

Get your flu shot if you haven't already


AFFINITY CAREERS

Learn more about Affinity Health Group's career opportunities




ACCESS AFFINITY'S
ONLINE PATIENT PORTAL

Get secure online access to important medical information with the Affinity
Patient Portal. Here, patients can access their medical information at any time.
Login now to see how convenient keeping track of your medical information can be
with instant online access.

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NEED AN APPOINTMENT?

Affinity Health Group makes it easy to schedule an appointment at any of our
clinics. Simply login to the Affinity Patient Portal to schedule an appointment
or give us a call at 318-807-4900 to schedule your appointment!

Login to Schedule an Appointment


PRACTICES


AFFINITY HMC




EXPRESS CARE




INDUSTRIAL MEDICINE




PEDIATRICS




PHARMACY




PRIMARY CARE




SPECIALTY




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WHAT MAKES
AFFINITY DIFFERENT?

Affinity Health Group isn’t just a collection of doctors. We pride ourselves in
our holistic approach to medicine, caring for our patients as a team, and
treating all of their problems with our wide variety of services. Our quality
care and patient-centered treatments make Affinity Health Group the best
healthcare provider in town!





CONTACT AFFINITY

At Affinity Health Group, our entire staff is committed to helping you. You can
contact us via mail, email or telephone.

All fields below are required for submission.

First Name
Last Name
Date of Birth
Phone
Email address
Message
Submit


300 DeSiard St, Monroe, LA 71201

Local: (318) 807-7875

TF: (866) 860-7510

Schedule an Appointment: (318) 807-4900


COMPLIANCE AND ETHICS

Hotline: 1-800-973-7707

Email: Email CED


REPORT FRAUD, WASTE, & ABUSE

Compliance and Ethics Hotline: 1-800-973-7707

Email: Email to report Fraud


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©2023 Affinity Health Group, LLC