portal.mindbodycenters.com Open in urlscan Pro
2606:4700:10::6816:3057  Public Scan

Form analysis
2 forms found in the DOM

POST

<form method="post" class="form-horizontal">
  <input type="hidden" name="action" value="create">
  <div class="form-group">
    <label for="firstName" class="col-sm-3 control-label">First Name</label>
    <div class="col-sm-9">
      <input type="text" class="form-control" name="firstName" id="firstName">
    </div>
  </div>
  <div class="form-group">
    <label for="lastName" class="col-sm-3 control-label">Last Name</label>
    <div class="col-sm-9">
      <input type="text" class="form-control" name="lastName" id="lastName">
    </div>
  </div>
  <div class="form-group">
    <label for="email" class="col-sm-3 control-label">Email</label>
    <div class="col-sm-9">
      <input type="text" class="form-control" name="email" id="email">
    </div>
  </div>
  <div class="form-group">
    <label for="cell" class="col-sm-3 control-label">Cell Phone</label>
    <div class="col-sm-9">
      <input type="text" class="form-control" name="cell" id="cell">
    </div>
  </div>
  <div class="form-group">
    <label for="location" class="col-sm-3 control-label">Location</label>
    <div class="col-sm-9">
      <select name="location" class="form-control" id="location">
        <option value="6">Gilbert</option>
        <option value="24">Burnsville</option>
        <option value="25">Littleton</option>
      </select>
    </div>
  </div>
  <div class="form-group">
    <div class="col-sm-offset-3 col-sm-9">
      <input type="submit" class="btn btn-default" name="submit" value="Create Account">
    </div>
  </div>
</form>

POST

<form method="post" class="form-horizontal">
  <input type="hidden" name="action" value="login">
  <div class="form-group">
    <label for="loginUsername" class="col-sm-3 control-label">Email</label>
    <div class="col-sm-9">
      <input type="text" name="email" id="email" class="form-control" value="" placeholder="Email">
    </div>
  </div>
  <div class="form-group">
    <div class="col-sm-offset-3 col-sm-9">
      <input type="submit" class="btn btn-default" name="submit" value="Login">
    </div>
  </div>
</form>

Text Content

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WELCOME TO YOUR SECURE PATIENT PORTAL


REGISTER

First Name

Last Name

Email

Cell Phone

Location
Gilbert Burnsville Littleton



LOGIN

Email



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