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URL:
https://hra.healthcaresource.com/user/respondReference?code=bc187037c9b3c89247514e904890926554bfa27a
Submission: On June 09 via api from US — Scanned from DE
Submission: On June 09 via api from US — Scanned from DE
Form analysis
1 forms found in the DOMPOST /user/respondReference?code=bc187037c9b3c89247514e904890926554bfa27a
<form action="/user/respondReference?code=bc187037c9b3c89247514e904890926554bfa27a" method="post">
<div style="text-align: left; margin-bottom: 10px">
<label> </label>
<div class="input ">
<input type="checkbox" value="1" name="agree" id="agree"> I agree to the <a target="_blank" href="/site/terms/role/Reference">Terms and Conditions</a>
</div>
</div>
<div class="actions centered">
<input class="btn special large" disabled="disabled" type="submit" name="yt1" value="Continue >>>">
</div>
</form>
Text Content
WELCOME! This invitation was created for Mr. Nicholas Apuzzo. You have been invited to complete a reference on behalf of Kathryn Pendergast. Please accept the terms and conditions below and follow the steps on each page. Kathryn has agreed to a release of liability to protect any information you provide. Click here to view and download the release if desired. I agree to the Terms and Conditions © 2022 HealthcareSource. All Rights Reserved. Warning!Close Your session is about to expire in minutes. Click here to continue your session! Cancel Browser Notification!Close The Healthcaresource / HRA system has identified that you are using an older browser. You may experience intermittent issues while using HRA. We recommend that you upgrade your browser to a newer version. Continue