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Submitted URL: https://link.email.2nd.md/ls/click?upn=uOJ7-2BsUDGWgk-2BZMwi7K5s1Jp12NnIbq8b2dDKAF4iZojQrahpQLYcvZt3ySohlyOnQptMkUixnM9QuE...
Effective URL: https://www.2nd.md/activate/step1/santander
Submission: On November 08 via api from ES — Scanned from ES
Effective URL: https://www.2nd.md/activate/step1/santander
Submission: On November 08 via api from ES — Scanned from ES
Form analysis 1 forms found in the DOM
POST /activate/step2/santander
<form id="activation" method="post" action="/activate/step2/santander" novalidate="">
<div id="activationMainRowDiv" class="d-block row">
<div class="body-container col container">
<div class="row">
<div class="col-12">
<div class="form-group">
<div class="d-flex align-items-center">
<label class="pl-0 form-label text-black montserrat bold-font">First Name</label>
<button type="button" class="btn btn-transparent btn-icon-info bold pl-2 mb-2 " aria-describedby="sr-covered-members" aria-label="First Name Tooltip" data-toggle="tooltip" data-html="true" trigger="hover focus" title=""
data-original-title="<span style='min-width: 5rem'>Covered members, please enter your first name as it appears in your organization's records.</span>">
<i class="fa fa-info-circle text-black"></i>
</button>
</div>
<div id="invalidFirstName" role="alert" tabindex="-1" aria-controls="first" class="invalid-feedback montserrat w-100">Please provide your first name</div>
<input type="text" id="first" name="first" data-click-countable="true" data-error-id="#invalidFirstName" class="form-control col-sm montserrat" value="" aria-label="first name input" autocomplete="given-name" required="">
</div>
</div>
<div class="col-12">
<div class="form-group">
<div class="d-flex align-items-center">
<label class="pl-0 form-label text-black montserrat bold-font">Last Name</label>
<button type="button" class="btn btn-transparent btn-icon-info bold pl-2 mb-2" aria-describedby="sr-covered-members" aria-label="Last Name Tooltip" data-toggle="tooltip" data-html="true" trigger="hover focus" title=""
data-original-title="<span style='min-width: 5rem'>Covered members, please enter your last name as it appears in your organization's records.</span>">
<i class="fa fa-info-circle text-black"></i>
</button>
</div>
<div id="invalidLastName" role="alert" tabindex="-1" aria-controls="last" class="invalid-feedback montserrat w-100">Please provide your last name</div>
<input type="text" id="last" name="last" data-click-countable="true" data-error-id="#invalidLastName" class="form-control col-sm montserrat" value="" aria-label="last name input" autocomplete="family-name" required="">
</div>
</div>
<div class="col-12">
<div class="form-group form-for-date flex-wrap flex-lg-nowrap d-flex d-sm-block flex-column">
<div class="d-flex align-items-center">
<label class="pl-0 form-label text-black montserrat bold-font">Date Of Birth</label>
</div>
<div id="invalidDateSelect" role="alert" tabindex="-1" aria-controls="month day year" class="invalid-feedback montserrat w-100">Please provide a valid birth date</div>
<div class="d-flex col-sm p-0">
<div id="divMonth" class="col-5 px-0 pr-1 selectable">
<label for="month" class="sr-only sr-only-focusable ">Month</label>
<select name="month" data-click-countable="true" data-error-id="#invalidDateSelect" id="month" class="form-control theSelect montserrat bold" required="">
<option aria-label="Select month of birth" value="">Month</option>
<option value="1" aria-label="January">January</option>
<option value="2" aria-label="February">February</option>
<option value="3" aria-label="March">March</option>
<option value="4" aria-label="April">April</option>
<option value="5" aria-label="May">May</option>
<option value="6" aria-label="June">June</option>
<option value="7" aria-label="July">July</option>
<option value="8" aria-label="August">August</option>
<option value="9" aria-label="September">September</option>
<option value="10" aria-label="October">October</option>
<option value="11" aria-label="November">November</option>
<option value="12" aria-label="December">December</option>
</select>
<div id="selectMonth"></div>
</div>
<div id="divDay" class="col-3 px-0 pr-1 selectable">
<label for="day" class="sr-only sr-only-focusable ">Day</label>
<select id="day" data-click-countable="true" data-error-id="#invalidDateSelect" name="day" class="form-control theSelect montserrat bold" required="">
<option aria-label="Select date of birth" value="">Day</option>
<option aria-label="1" value="1">1</option>
<option aria-label="2" value="2">2</option>
<option aria-label="3" value="3">3</option>
<option aria-label="4" value="4">4</option>
<option aria-label="5" value="5">5</option>
<option aria-label="6" value="6">6</option>
<option aria-label="7" value="7">7</option>
<option aria-label="8" value="8">8</option>
<option aria-label="9" value="9">9</option>
<option aria-label="10" value="10">10</option>
<option aria-label="11" value="11">11</option>
<option aria-label="12" value="12">12</option>
<option aria-label="13" value="13">13</option>
<option aria-label="14" value="14">14</option>
<option aria-label="15" value="15">15</option>
<option aria-label="16" value="16">16</option>
<option aria-label="17" value="17">17</option>
<option aria-label="18" value="18">18</option>
<option aria-label="19" value="19">19</option>
<option aria-label="20" value="20">20</option>
<option aria-label="21" value="21">21</option>
<option aria-label="22" value="22">22</option>
<option aria-label="23" value="23">23</option>
<option aria-label="24" value="24">24</option>
<option aria-label="25" value="25">25</option>
<option aria-label="26" value="26">26</option>
<option aria-label="27" value="27">27</option>
<option aria-label="28" value="28">28</option>
<option aria-label="29" value="29">29</option>
<option aria-label="30" value="30">30</option>
<option aria-label="31" value="31">31</option>
</select>
<div id="selectDay"></div>
</div>
<div id="divYear" class="col-4 px-0 selectable">
<label for="year" class="sr-only sr-only-focusable ">Year</label>
<select id="year" data-click-countable="true" data-error-id="#invalidDateSelect" name="year" class="form-control theSelect montserrat bold" required="">
<option aria-label="Select year of birth" value="">Year</option>
<option aria-label="2023" value="2023">2023</option>
<option aria-label="2022" value="2022">2022</option>
<option aria-label="2021" value="2021">2021</option>
<option aria-label="2020" value="2020">2020</option>
<option aria-label="2019" value="2019">2019</option>
<option aria-label="2018" value="2018">2018</option>
<option aria-label="2017" value="2017">2017</option>
<option aria-label="2016" value="2016">2016</option>
<option aria-label="2015" value="2015">2015</option>
<option aria-label="2014" value="2014">2014</option>
<option aria-label="2013" value="2013">2013</option>
<option aria-label="2012" value="2012">2012</option>
<option aria-label="2011" value="2011">2011</option>
<option aria-label="2010" value="2010">2010</option>
<option aria-label="2009" value="2009">2009</option>
<option aria-label="2008" value="2008">2008</option>
<option aria-label="2007" value="2007">2007</option>
<option aria-label="2006" value="2006">2006</option>
<option aria-label="2005" value="2005">2005</option>
<option aria-label="2004" value="2004">2004</option>
<option aria-label="2003" value="2003">2003</option>
<option aria-label="2002" value="2002">2002</option>
<option aria-label="2001" value="2001">2001</option>
<option aria-label="2000" value="2000">2000</option>
<option aria-label="1999" value="1999">1999</option>
<option aria-label="1998" value="1998">1998</option>
<option aria-label="1997" value="1997">1997</option>
<option aria-label="1996" value="1996">1996</option>
<option aria-label="1995" value="1995">1995</option>
<option aria-label="1994" value="1994">1994</option>
<option aria-label="1993" value="1993">1993</option>
<option aria-label="1992" value="1992">1992</option>
<option aria-label="1991" value="1991">1991</option>
<option aria-label="1990" value="1990">1990</option>
<option aria-label="1989" value="1989">1989</option>
<option aria-label="1988" value="1988">1988</option>
<option aria-label="1987" value="1987">1987</option>
<option aria-label="1986" value="1986">1986</option>
<option aria-label="1985" value="1985">1985</option>
<option aria-label="1984" value="1984">1984</option>
<option aria-label="1983" value="1983">1983</option>
<option aria-label="1982" value="1982">1982</option>
<option aria-label="1981" value="1981">1981</option>
<option aria-label="1980" value="1980">1980</option>
<option aria-label="1979" value="1979">1979</option>
<option aria-label="1978" value="1978">1978</option>
<option aria-label="1977" value="1977">1977</option>
<option aria-label="1976" value="1976">1976</option>
<option aria-label="1975" value="1975">1975</option>
<option aria-label="1974" value="1974">1974</option>
<option aria-label="1973" value="1973">1973</option>
<option aria-label="1972" value="1972">1972</option>
<option aria-label="1971" value="1971">1971</option>
<option aria-label="1970" value="1970">1970</option>
<option aria-label="1969" value="1969">1969</option>
<option aria-label="1968" value="1968">1968</option>
<option aria-label="1967" value="1967">1967</option>
<option aria-label="1966" value="1966">1966</option>
<option aria-label="1965" value="1965">1965</option>
<option aria-label="1964" value="1964">1964</option>
<option aria-label="1963" value="1963">1963</option>
<option aria-label="1962" value="1962">1962</option>
<option aria-label="1961" value="1961">1961</option>
<option aria-label="1960" value="1960">1960</option>
<option aria-label="1959" value="1959">1959</option>
<option aria-label="1958" value="1958">1958</option>
<option aria-label="1957" value="1957">1957</option>
<option aria-label="1956" value="1956">1956</option>
<option aria-label="1955" value="1955">1955</option>
<option aria-label="1954" value="1954">1954</option>
<option aria-label="1953" value="1953">1953</option>
<option aria-label="1952" value="1952">1952</option>
<option aria-label="1951" value="1951">1951</option>
<option aria-label="1950" value="1950">1950</option>
<option aria-label="1949" value="1949">1949</option>
<option aria-label="1948" value="1948">1948</option>
<option aria-label="1947" value="1947">1947</option>
<option aria-label="1946" value="1946">1946</option>
<option aria-label="1945" value="1945">1945</option>
<option aria-label="1944" value="1944">1944</option>
<option aria-label="1943" value="1943">1943</option>
<option aria-label="1942" value="1942">1942</option>
<option aria-label="1941" value="1941">1941</option>
<option aria-label="1940" value="1940">1940</option>
<option aria-label="1939" value="1939">1939</option>
<option aria-label="1938" value="1938">1938</option>
<option aria-label="1937" value="1937">1937</option>
<option aria-label="1936" value="1936">1936</option>
<option aria-label="1935" value="1935">1935</option>
<option aria-label="1934" value="1934">1934</option>
<option aria-label="1933" value="1933">1933</option>
<option aria-label="1932" value="1932">1932</option>
<option aria-label="1931" value="1931">1931</option>
<option aria-label="1930" value="1930">1930</option>
<option aria-label="1929" value="1929">1929</option>
<option aria-label="1928" value="1928">1928</option>
<option aria-label="1927" value="1927">1927</option>
<option aria-label="1926" value="1926">1926</option>
<option aria-label="1925" value="1925">1925</option>
<option aria-label="1924" value="1924">1924</option>
<option aria-label="1923" value="1923">1923</option>
</select>
<div id="selectYear"></div>
</div>
</div>
</div>
</div>
<div class="col-12">
<input id="corporate_id" name="corporate_id" type="hidden" value="4454">
<div id="activationRecaptchaContainer" class="form-group flex-wrap" style="display:none" data-recaptcha-key="activation.fail.cnt.20018233172.71.150.134" data-show-recaptcha="" data-fail-count="0">
<label for="activationRecaptcha" class="pl-0 form-label text-black montserrat bold-font"></label>
<div id="activationRecaptchaAlert" tabindex="-1" aria-atomic="true" role="alert" class="invalid-feedback">Please complete the reCAPTCHA verification. </div>
<div id="activationRecaptcha" data-sitekey="6Ld1WKUUAAAAALhGWVPgS008F545wwVDGXF9r_sX"></div>
</div>
</div>
<input type="hidden" name="data" value="{"short":"santander","ci_csrf_token":"76b5990d8e42d00a564067737c73c288"}"
data-form-data="{"short":"santander","ci_csrf_token":"76b5990d8e42d00a564067737c73c288"}">
<input type="hidden" name="l_google_client_id" value="">
<input type="hidden" name="client_comp" id="client_comp" value="4454">
<input type="hidden" name="client_obf_email" id="client_obf_email" value="">
<div class="col-12">
<div class="form-group pt-0 pb-1 py-md-0 m-0 text-center">
<button id="nextStep" type="button" aria-label="next step" class="btn w-75 mx-auto bold steps mr-1">Next Step</button>
</div>
</div>
<div class="col-12 pt-3 pb-1 pt-md-2 text-center">
<span class="text-dark">Already have an account? </span> <a href="https://www.2nd.md/login" class="text-dark text-underline">Sign in</a>
</div>
<div class="col-12 py-0 pt-md-2 text-center">
<p class="normal-font mb-0">Step 1 of 3</p>
<a href="#ot-sdk-btn" id="ot-sdk-btn" class="ot-sdk-show-settings px-3 py-0 text-dark" role="button">Manage Cookies</a>
</div>
<div class="col-12 py-1 pt-md-0">
<p class="mb-0 text-dark-gray lato normal-font text-center"> <i class="fas fa-lock"></i> Data will be sent and processed securely<br> SSL encrypted and SOC2 attested</p>
</div>
</div>
</div>
</div>
</form>Text Content
Members: Phone Number 1.866.269.3534 ACTIVATE LOGIN * ABOUT * SERVICES * TESTIMONIALS * WEBINARS * CONTACT Members: Phone Number 1.866.269.3534 Doctors: Phone Number 1.281.990.3673 Business Relations: Phone Number 1.866.410.8650 ACTIVATE LOGIN LOGIN Login ACTIVATE VERIFY COVERAGE AND CREATE ACCOUNT Your sponsoring organization offers 2nd.MD as a covered benefit at no cost to you. Need help registering? 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