www.instamed.com Open in urlscan Pro
2606:4700:7::a29f:8650  Public Scan

Form analysis
2 forms found in the DOM

GET https://www.instamed.com/

<form method="get" id="searchform" class="searchform" autocomplete="off" action="https://www.instamed.com/" role="search">
  <input type="search" class="field" name="s" value="" id="s" placeholder="Search …">
  <label class="search-icon-label">
    <input type="submit" class="submit" id="searchsubmit" value="Search">
    <svg class="search-icon" width="15" height="15" style="fill: #005596;
    position: absolute;
    right: 10px;
    width: 15px;
    top: 7px;" viewBox="0 0 40 40" xmlns="http://www.w3.org/2000/svg">
      <path
        d="M24.828 31.657a16.76 16.76 0 0 1-7.992 2.015C7.538 33.672 0 26.134 0 16.836 0 7.538 7.538 0 16.836 0c9.298 0 16.836 7.538 16.836 16.836 0 3.22-.905 6.23-2.475 8.79.288.18.56.395.81.645l5.985 5.986A4.54 4.54 0 0 1 38 38.673a4.535 4.535 0 0 1-6.417-.007l-5.986-5.986a4.545 4.545 0 0 1-.77-1.023zm-7.992-4.046c5.95 0 10.775-4.823 10.775-10.774 0-5.95-4.823-10.775-10.774-10.775-5.95 0-10.775 4.825-10.775 10.776 0 5.95 4.825 10.775 10.776 10.775z"
        fill-rule="evenodd"></path>
    </svg>
  </label>
</form>

POST /wp-content/themes/instamed2/pdf-submit.php

<form id="pdf_form" action="/wp-content/themes/instamed2/pdf-submit.php" method="POST" novalidate="novalidate">
  <input type="hidden" value="45.131.95.89" name="ip_address" id="ip_address">
  <p class="pdf">Download PDF</p>
  <p>Thank you for your interest in InstaMed. Please complete and submit the webform below and your PDF Download will become available.</p>
  <ul>
    <li>
      <label>First Name</label>
      <input type="text" name="first_name" value="">
    </li>
    <li>
      <label>Last Name</label>
      <input type="text" name="last_name" value="">
    </li>
    <li>
      <label>Company</label>
      <input type="text" name="company" value="">
    </li>
    <li>
      <label>Phone</label>
      <input type="text" name="phone" value="">
    </li>
    <li>
      <label>Email</label>
      <input type="text" name="email" value="">
    </li>
    <li class="select">
      <label>How did you hear about InstaMed?</label>
      <select name="source_name">
        <option value="">- Select -</option>
        <option value="InstaMed Partner">InstaMed Partner</option>
        <option value="Print Ad">Print Ad</option>
        <option value="Search">Search</option>
        <option value="Web Ad">Web Ad</option>
        <option value="Mailer">Mailer</option>
        <option value="Email">Email</option>
        <option value="Conference">Conference</option>
        <option value="Referral">Referral/Word of Mouth</option>
        <option value="Other">Other</option>
      </select>
    </li>
    <li class="pdf_hide other">
      <label>* <strong>Other</strong></label>
      <input type="text" name="source_other" value="">
    </li>
    <li class="btns">
      <input type="hidden" name="pdf_name" value="">
      <input type="submit" value="Submit" name="submit">
      <a href="#" class="cancel"><span>Cancel</span></a>
    </li>
  </ul>
</form>

Text Content

InstaMed

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 * About
 * Contact
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 * InstaMed Service Guarantee

InstaMed is a wholly owned subsidiary and is a registered MSP/ISO of JPMorgan
Chase Bank, N.A. Additionally, InstaMed is a registered ISO of Wells Fargo Bank,
N.A., Concord, CA; a registered ISO of U.S. Bank, N.A.; and a registered MSP/ISO
of Elavon, Inc. Georgia.

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Download PDF

Thank you for your interest in InstaMed. Please complete and submit the webform
below and your PDF Download will become available.

 * First Name
 * Last Name
 * Company
 * Phone
 * Email
 * How did you hear about InstaMed? - Select - InstaMed Partner Print Ad Search
   Web Ad Mailer Email Conference Referral/Word of Mouth Other
 * * Other
 * Cancel

THANK YOU FOR YOUR INTEREST IN INSTAMED.

Please click the link below to download your PDF.

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