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Submission: On December 09 via api from US — Scanned from US
Submission: On December 09 via api from US — Scanned from US
Form analysis
1 forms found in the DOMPOST /
<form method="post" enctype="multipart/form-data" id="gform_1" action="/" data-formid="1" novalidate="">
<div class="gform-body gform_body">
<div id="gform_fields_1" class="gform_fields top_label form_sublabel_below description_below">
<fieldset id="field_1_6" class="gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_1_6">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_1_6">
<span id="input_1_6_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_6.3" id="input_1_6_3" value="" aria-required="true" placeholder="First">
<label for="input_1_6_3" class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">First</label>
</span>
<span id="input_1_6_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_6.6" id="input_1_6_6" value="" aria-required="true" placeholder="Last">
<label for="input_1_6_6" class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">Last</label>
</span>
</div>
</fieldset>
<div id="field_1_3" class="gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_1_3"><label
class="gfield_label gform-field-label" for="input_1_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_1_3" type="tel" value="" class="large" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_1_4" class="gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_1_4"><label
class="gfield_label gform-field-label" for="input_1_4">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_4" id="input_1_4" type="email" value="" class="large" aria-required="true" aria-invalid="false">
</div>
</div>
<div id="field_1_5" class="gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_1_5"><label
class="gfield_label gform-field-label" for="input_1_5">Message<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_5" id="input_1_5" class="textarea small" aria-required="true" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<div id="field_1_7" class="gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_1_7"><label
class="gfield_label gform-field-label" for="input_1_7">Phone</label>
<div class="ginput_container"><input name="input_7" id="input_1_7" type="text" value="" autocomplete="new-password"></div>
<div class="gfield_description" id="gfield_description_1_7">This field is for validation purposes and should be left unchanged.</div>
</div>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_1" class="gform_button button" value="Submit"
onclick="if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} jQuery("#gform_1").trigger("submit",[true]); }">
<input type="hidden" class="gform_hidden" name="is_submit_1" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="1">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_1" value="WyJbXSIsIjBmM2ZmZjYxYzdhYTI4MDM4MjMzM2MxYTA3ZDk3MTRmIl0=">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_1" id="gform_target_page_number_1" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_1" id="gform_source_page_number_1" value="1">
<input type="hidden" name="gform_field_values" value="">
</div>
</form>
Text Content
* Pay Online * Membership * Careers * About Us * Contact Select Page * Pay Online * Membership * Careers * About Us * Contact HELP ME WITH… BILL PAY Pay your ambulance bill. Pay Now CAREERS Work with MGC EMS. See Openings MEMBERSHIP Create your membership. Get Started CONTACT US Questions? Get in touch. Name* First Last Phone* Email* Message* Phone This field is for validation purposes and should be left unchanged. EMERGENCY? Dial 9-1-1 for medical emergencies MAILING ADDRESS McClain/Grady County E.M.S. P.O. Box 430 Blanchard, OK 73010 CONNECT * * Careers © McClain/Grady County EMS | EMS Website Design by Aqua Vita Creative Notifications