www.davila.cl
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66.22.101.13
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Submitted URL: https://trackercl1.fidelizador.com/LA9FF7818GF1D0A0HD7B3570BCA0BJ10EC55C2FAKA9FF781891175E6AA4B335A0515B71
Effective URL: https://www.davila.cl/formulario-campana-seguro-cirugia-copago-desde-cero/?utm_source=fidelizador&utm_medium=email&utm...
Submission: On November 11 via manual from CL — Scanned from DE
Effective URL: https://www.davila.cl/formulario-campana-seguro-cirugia-copago-desde-cero/?utm_source=fidelizador&utm_medium=email&utm...
Submission: On November 11 via manual from CL — Scanned from DE
Form analysis
3 forms found in the DOMGET /
<form role="search" method="get" class="et-search-form" action="/">
<input type="search" class="et-search-field" placeholder="Búsqueda …" value="" name="s" title="Buscar:">
</form>
<form data-auto-scroll="" data-no-message-redirect="false" data-thousand="" data-decimal="." data-delay="" data-id="122"
class="fc-form fc-form-122 align- save-form- remove-asterisk- icons-hide- disable-enter- label-block field-border-visible frame-visible dont-submit-hidden-false field-alignment-left options-fade align-left"
style="width: 100%; color: #666666; font-size: 100%; background: white">
<!-- ngRepeat: page in Builder.FormElements track by $index -->
<div class="form-page form-page-0 active" data-index="0">
<div class="form-page-content ng-not-empty">
<div data-identifier="field1" data-index="0" style="width: 50%" class=" form-element form-element-field1 options-false index-false form-element-0 default-false form-element-type-oneLineText is-required-true odd -handle">
<div class="form-element-html">
<div><label class="oneLineText-cover field-cover"><span class="sub-label-false"><span class="main-label"><span>Nombre</span></span><span class="sub-label"></span></span>
<div><span class="error"></span><input type="text" placeholder="" make-read-only="false" data-field-id="field1" name="field1[]" data-min-char="5" data-max-char="20" data-val-type="alphabets" data-regexp="" data-is-required="true"
data-allow-spaces="true" class="validation-lenient" data-placement="right" data-toggle="tooltip" tooltip="" data-trigger="focus" data-html="true" data-input-mask="" data-mask-placeholder="" data-original-title=""></div>
</label></div>
</div>
</div>
<div data-identifier="field42" data-index="1" style="width: 50%" class=" even form-element form-element-field42 options-false index-false form-element-1 default-false form-element-type-oneLineText is-required-true -handle">
<div class="form-element-html">
<div><label class="oneLineText-cover field-cover"><span class="sub-label-false"><span class="main-label"><span>Apellido</span></span><span class="sub-label"></span></span>
<div><span class="error"></span><input type="text" placeholder="" make-read-only="false" data-field-id="field42" name="field42[]" data-min-char="5" data-max-char="40" data-val-type="alphabets" data-regexp="" data-is-required="true"
data-allow-spaces="true" class="validation-lenient" data-placement="right" data-toggle="tooltip" tooltip="" data-trigger="focus" data-html="true" data-input-mask="" data-mask-placeholder="" data-original-title=""></div>
</label></div>
</div>
</div>
<div data-identifier="field45" data-index="2" style="width: 50%" class=" form-element form-element-field45 form-element-2 default-false form-element-type-dropdown is-required-true odd -handle options-true index-true">
<div class="form-element-html">
<div><label class="dropdown-cover field-cover autocomplete-type- has-input"><span class="sub-label-false"><span class="main-label"><span>Previsión</span></span><span class="sub-label"></span></span>
<div><span class="error"></span><select data-is-required="true" class="validation-lenient" data-field-id="field45" name="field45" data-placement="right" data-toggle="tooltip" tooltip="" data-trigger="hover" data-html="true"
data-original-title="">
<option value="" class=" ">Seleccione una opción</option>
<option value="Banmédica" class=" ">Banmédica</option>
<option value="Chuquicamata" class=" ">Chuquicamata</option>
<option value="Colmena Golden Cross." class=" ">Colmena Golden Cross.</option>
<option value="Consalud" class=" ">Consalud</option>
<option value="Cruz Blanca" class=" ">Cruz Blanca</option>
<option value="Cruz del Norte" class=" ">Cruz del Norte</option>
<option value="Nueva Masvida" class=" ">Nueva Masvida</option>
<option value="Fundación" class=" ">Fundación</option>
<option value="Fusat" class=" ">Fusat</option>
<option value="Río Blanco" class=" ">Río Blanco</option>
<option value="San Lorenzo" class=" ">San Lorenzo</option>
<option value="Vida Tres" class=" ">Vida Tres</option>
<option value="OTRO" class=" ">OTRO</option>
</select><input type="text"></div>
</label></div>
</div>
</div>
<div data-identifier="field46" data-index="3" style="width: 50%" class=" even form-element form-element-field46 options-false index-false form-element-3 default-false form-element-type-datepicker is-required-true -handle">
<div class="form-element-html">
<div><label class="datepicker-cover field-cover"><span class="sub-label-false"><span class="main-label"><span>Fecha de nacimiento</span></span><span class="sub-label"></span></span>
<div><span class="error"></span><input autocomplete="off" data-field-id="field46" placeholder="" type="text" class="validation-lenient ng-empty hasDatepicker" data-is-required="true" datepicker="" data-date-min-range=""
data-date-format="dd/mm/yy" data-date-days="{"0":true,"1":true,"2":true,"3":true,"4":true,"5":true,"6":true}" data-date-min="" data-date-min-alt=""
data-date-max-alt="" data-date-max="" data-date-lang="en" name="field46" data-placement="right" data-toggle="tooltip" tooltip="" data-trigger="focus" data-html="true" data-original-title=""
id="dp1699662689866"><i class="formcraft-icon">date_range</i></div>
</label></div>
</div>
</div>
<div data-identifier="field39" data-index="4" style="width: 50%" class=" form-element form-element-field39 options-false index-false form-element-4 default-false form-element-type-oneLineText is-required-true odd -handle">
<div class="form-element-html">
<div><label class="oneLineText-cover field-cover"><span class="sub-label-true"><span class="main-label"><span>Rut</span></span><span class="sub-label"><span>Sin puntos y con guion</span></span></span>
<div><span class="error"></span><input type="text" placeholder="" make-read-only="false" data-field-id="field39" name="field39[]" data-min-char="" data-max-char="" data-val-type="" data-regexp="" data-is-required="true"
data-allow-spaces="" class="validation-lenient" data-placement="right" data-toggle="tooltip" tooltip="" data-trigger="focus" data-html="true" data-input-mask="" data-mask-placeholder=""
data-original-title=""><i class="formcraft-icon formcraft-icon-type-view_comfy">view_comfy</i></div>
</label></div>
</div>
</div>
<div data-identifier="field6" data-index="5" style="width: 50%" class=" even form-element form-element-field6 options-false index-false form-element-5 default-false form-element-type-oneLineText is-required-true -handle">
<div class="form-element-html">
<div><label class="oneLineText-cover field-cover"><span class="sub-label-true"><span class="main-label"><span>Celular</span></span><span class="sub-label"><span>Formato 9 XXXX XXXX</span></span></span>
<div><span class="error"></span><input type="text" placeholder="" make-read-only="false" data-field-id="field6" name="field6[]" data-min-char="9" data-max-char="9" data-val-type="numbers" data-regexp="" data-is-required="true"
data-allow-spaces="true" class="validation-lenient" data-placement="right" data-toggle="tooltip" tooltip="" data-trigger="focus" data-html="true" data-input-mask="" data-mask-placeholder="" data-original-title=""></div>
</label></div>
</div>
</div>
<div data-identifier="field47" data-index="6" style="width: 50%" class=" form-element form-element-field47 options-false index-false form-element-6 default-false form-element-type-email is-required-true odd -handle">
<div class="form-element-html">
<div><label class="email-cover field-cover"><span class="sub-label-true"><span class="main-label"><span>Correo de contacto</span></span><span class="sub-label"></span></span>
<div><span class="error"></span><input placeholder="" data-field-id="field47" type="text" data-val-type="email" make-read-only="" data-is-required="true" name="field47" class="validation-lenient" data-placement="right"
data-toggle="tooltip" tooltip="" data-trigger="focus" data-html="true" data-original-title=""><i class="formcraft-icon">email</i></div>
</label></div>
</div>
</div>
<div data-identifier="field49" data-index="7" style="width: 50%" class=" even form-element form-element-field49 form-element-7 default-false form-element-type-dropdown is-required-true -handle options-false index-false">
<div class="form-element-html">
<div><label class="dropdown-cover field-cover autocomplete-type- has-input"><span class="sub-label-false"><span class="main-label"><span>¿Dónde quieres atenderte?</span></span><span class="sub-label"></span></span>
<div><span class="error"></span><select data-is-required="true" class="validation-lenient" data-field-id="field49" name="field49" data-placement="right" data-toggle="tooltip" tooltip="" data-trigger="hover" data-html="true"
data-original-title="">
<option value="" class=" ">Selecciona una opción</option>
<option value="Clinica Dávila " class=" ">Clinica Dávila </option>
<option value="Clínica Dávila Vespucio" class=" ">Clínica Dávila Vespucio</option>
</select><input type="text"></div>
</label></div>
</div>
</div>
<div data-identifier="field53" data-index="8" style="width: 50%" class=" form-element form-element-field53 options-false index-false form-element-8 default-false form-element-type-dropdown is-required-true odd -handle">
<div class="form-element-html">
<div><label class="dropdown-cover field-cover autocomplete-type- has-input"><span class="sub-label-false"><span class="main-label"><span>¿Tienes activado tu seguro Dávila Contigo?</span></span><span class="sub-label"></span></span>
<div><span class="error"></span><select data-is-required="true" class="validation-lenient" data-field-id="field53" name="field53" data-placement="right" data-toggle="tooltip" tooltip="" data-trigger="hover" data-html="true"
data-original-title="">
<option value="" class=" ">Selecciona una opción</option>
<option value="Sí" class=" ">Sí</option>
<option value="No" class=" ">No</option>
</select><input type="text"></div>
</label></div>
</div>
</div>
<div data-identifier="field40" data-index="9" style="width: 100%" class=" even form-element form-element-field40 options-false index-false form-element-9 default-false form-element-type-customText is-required-false -handle">
<div class="form-element-html">
<div>
<div class="absolute-false customText-cover field-cover" style="left: ; top: ;right: ;bottom: ;color: #666666 !important; background-color:">
<div class="full" style="text-align: left">
<p></p>
<p style="text-align: right;color: #ff5a5a">* Campos obligatorios</p>
<p></p>
</div><input type="hidden" name="field40" data-field-id="field40">
</div>
</div>
</div>
</div>
<div data-identifier="field41" data-index="10" style="width: 100%" class=" form-element form-element-field41 options-false index-false form-element-10 default-false form-element-type-reCaptcha is-required-false odd -handle">
<div class="form-element-html">
<div>
<div data-site-key="6LebxWgdAAAAANuQdiBCVQVCXUwNB-L_F46MtqJz" class="captcha-placeholder ">reCaptcha v3</div><input type="hidden" class="recaptcha-token " name="recaptcha-token">
</div>
</div>
</div>
<div data-identifier="field48" data-index="11" style="width: 100%" class=" even form-element form-element-field48 options-false index-false form-element-11 default-false form-element-type-submit is-required-false -handle">
<div class="form-element-html">
<div>
<div class="align-center wide-false submit-cover field-cover"><button type="submit" class="button submit-button"><span class="text ">Enviar</span><span
class="spin-cover"><i style="color:" class="loading-icon icon-cog animate-spin"></i></span></button></div>
<div class="submit-response "></div><label><input type="text" class="required_field" name="website" autocomplete="maple-syrup-pot" style="display: none;"></label>
</div>
</div>
</div>
</div>
</div><!-- end ngRepeat: page in Builder.FormElements track by $index -->
</form>
GET /
<form id="searchform" class="searchform footer" role="search" action="/" method="get">
<div><label class="screen-reader-text" for="s">Buscar:</label><br>
<i class="fa fa-search" aria-hidden="true"></i><input id="s" class="query" name="s" type="text" value=""><br>
<input id="searchsubmit" class="submit" type="submit" value="Buscar">
</div>
</form>
Text Content
* Clínica Dávila Vespucio * Dávila Las Condes * Dávila Ñuñoa * Dávila Maipú * * Reserva de hora >> * Presencial * Dental * Atención Inmediata * Telemedicina * Mesa Central 2 2270 2700 * Reserva de horas 2 2270 2700 * * Nosotros * Especialidades * Servicios y unidades * Seguros y convenios * Coberturas GES/CAEC * Bono PAD * Seguros Dávila Contigo * Información paciente * Servicios en línea * Reserva de horas * Telemedicina * Resultados Imagenología * Resultados Laboratorio * Ticket virtual * Solicitar presupuesto * Pago de cuentas Seleccionar página * * Nosotros * Especialidades * Servicios y unidades * Seguros y convenios * Información paciente * Clínica Dávila Vespucio * Dávila Las Condes * Dávila Ñuñoa * Dávila Maipú * * Reserva de hora >> * Presencial * Dental * Atención Inmediata * Telemedicina Si ya tienes contratado tu Seguro Dávila Contigo te queremos entregar un beneficio exclusivo para tu próxima cirugía. ¡CONTÁCTANOS PARA ACCEDER A ESTE BENEFICIO! ¡CONTÁCTANOS PARA ACCEDER A ESTE BENEFICIO! PAQUETES QUIRÚRGICOS CON COPAGO DE $0 Y $100.000 Para pacientes Isapre con seguro Dávila Contigo vigente 1 Step 1 Nombre Apellido Previsión Seleccione una opciónBanmédicaChuquicamataColmena Golden Cross.ConsaludCruz BlancaCruz del NorteNueva MasvidaFundaciónFusatRío BlancoSan LorenzoVida TresOTRO Fecha de nacimiento date_range RutSin puntos y con guion view_comfy CelularFormato 9 XXXX XXXX Correo de contacto email ¿Dónde quieres atenderte? Selecciona una opciónClinica Dávila Clínica Dávila Vespucio ¿Tienes activado tu seguro Dávila Contigo? Selecciona una opciónSíNo * Campos obligatorios reCaptcha v3 Enviar keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder CIRUGÍAS CON COPAGO $0 * Vasectomía bilateral * Varicocele * Dedos en gatillo * Tratamiento quirúrgico mucositis * Tendovaginosis de Quervain * Liberación quirúrgica de nervio periférico CIRUGÍAS CON COPAGO $100.000 * Circuncisión * Adenoidectomía * Safenectomía con ligadura unilateral y bilateral * Facoeresis extracapsular con implante * Chalazión y otros tumores benignos * Condilomas anales * Adenoidectomía y tratamiento quirúgico mucositosis * Ubicaciones * Dávila Vespucio * Av. Serafín Zamora 190, La Florida, RM * Dávila Recoleta * Av. Recoleta 464, Recoleta, RM * Dávila Las Condes * Av. El Bosque Norte 0110, Las Condes, RM * Dávila Ñuñoa * Av. Irarrázaval 2401, Ñuñoa, RM * Dávila Maipú * Av. Pajaritos 1948, Maipú, RM * Mesa central 2 2730 8000 * Reserva de horas 2 2270 2700 * Buscar: Síguenos * Proveedores * Acceso a profesionales * Trabaja con nosotros * Aranceles * Reclamos * Felicitaciones * Sugerencias * Centro de ayuda de ética y cumplimiento * 2 2730 8000 Mesa central * * 2 2270 2700 Reserva de horas