customeracceptance.achhealthcheck.com Open in urlscan Pro
150.202.2.42  Public Scan

Form analysis
1 forms found in the DOM

POST /Login

<form action="/Login" class="needs-validation" method="post" novalidate="novalidate"><input name="__RequestVerificationToken" type="hidden"
    value="R-WPsxsW0S9hTrs3M_DrxtCuzERwHEopXBHe6y-6S4FUwau8_TjwXqypjTVg-QzwFl2N8dElu3caJmcIc1RtqkdLeTaB-uFihxLrB9b1gSo1">
  <div id="sectionPSTID">
    <div class="form-group-lg loginPST loginPSTLoginDetails" style="margin-bottom:10px;">
      <label>DATE OF BIRTH:</label>
      <input class="form-control login-control text-box single-line" data-val="false" data-val-regex="The field DOB must match the regular expression '^(0?[1-9]|1[012])[- /.](0?[1-9]|[12][0-9]|3[01])[- /.](19|20)\d\d$'."
        data-val-regex-pattern="^(0?[1-9]|1[012])[- /.](0?[1-9]|[12][0-9]|3[01])[- /.](19|20)\d\d$" data-val-requiredifattribute="The field  is invalid." data-val-requiredifattribute-requiredifattribute="IsLoginPSTID" id="DOB" max="2021-08-25"
        name="DOB" placeholder="mm/dd/yyyy" required="required" type="text" value="">
    </div>
    <div class="form-group-lg loginPST loginPSTLoginDetails" style="margin-bottom:10px;">
      <label>ID:</label>
      <input class="form-control login-control text-box single-line" data-val="true" data-val-number="The field PatientID must be a number." data-val-requiredifattribute="The field  is invalid."
        data-val-requiredifattribute-requiredifattribute="IsLoginPSTID" id="PatientID" name="PatientID" required="required" type="number" value="">
    </div>
    <div class="form-group-lg loginPST" style="margin-bottom:10px;">
      <label>PIN:</label>
      <div class="input-group mb-3">
        <input class="form-control login-control text-box single-line password" data-val="true" data-val-number="The field PIN must be a number." data-val-requiredifattribute="The field  is invalid."
          data-val-requiredifattribute-requiredifattribute="IsLoginPSTID" id="PIN" name="PIN" required="required" type="password">
        <div class="input-group-append" style="border:1px #fff !important;">
          <a href="#" onclick="javascript: showHidePassword(this);" class="input-group-text"><span style="color:#494949;" class="bi bi-eye"></span></a>
        </div>
      </div>
    </div>
  </div>
  <div id="sectionEmail" style="display: none;">
    <div class="form-group-lg loginEmail" style="margin-bottom:10px;">
      <label>Email</label>
      <input class="form-control login-control text-box single-line" data-val="true" data-val-requiredifattribute="The field  is invalid." data-val-requiredifattribute-requiredifattribute="IsLoginPSTID" id="EmailAddress" name="EmailAddress"
        type="email" value="" disabled="disabled">
    </div>
    <div class="form-group-lg loginEmail" style="margin-bottom:10px;">
      <label>Password</label>
      <div class="input-group mb-3">
        <input class="form-control login-control text-box single-line password" data-val="true" data-val-requiredifattribute="The field Password is invalid." data-val-requiredifattribute-requiredifattribute="IsLoginPSTID" id="Password"
          name="Password" type="password" disabled="disabled">
        <div class="input-group-append" style="border:1px #fff !important;">
          <a href="#" onclick="javascript: showHidePassword(this);" class="input-group-text"><span style="color:#494949;" class="bi bi-eye"></span></a>
        </div>
      </div>
    </div>
  </div>
  <div class="custom-control custom-checkbox loginPSTLoginDetails">
    <input class="custom-control-input" data-val="true" data-val-required="The RememberMe field is required." id="RememberMe" name="RememberMe" type="checkbox" value="true"><input name="RememberMe" type="hidden" value="false">
    <label for="RememberMe" class="custom-control-label">Remember me</label>
  </div>
  <div class="row" style="margin-top:10px;">
    <div class="col">
      <button type="submit" id="btnSUbmit" style="width:100%;" class="btn btn-primary">SIGN IN</button>
      <div style="display: none;">
        <input data-val="true" data-val-required="The IsLoginPSTID field is required." id="IsLoginPSTID" name="IsLoginPSTID" type="hidden" value="True">
        <input data-val="true" data-val-required="The IsForgotPassword field is required." id="IsForgotPassword" name="IsForgotPassword" type="checkbox" value="true"><input name="IsForgotPassword" type="hidden" value="false">
      </div>
    </div>
    <div class="col-7" style="padding-left:0px !important;">
      <div class="text-right" style="font-size: 16px;">
        <ul style="list-style-type:none;">
          <li class="bullet-lists" id="btnLoginEmailBullet"><a href="#" class="text-medium-blue" id="btnLoginEmail">Sign in with email</a></li>
          <li class="bullet-lists" style="display: none;"><a href="#" class="text-medium-blue" id="btnShowLoginDetails">Display login details</a></li>
          <li class="bullet-lists" id="btnLoginPSTIDBullet" style="display: none;"><a href="#" id="btnLoginPSTID" class="text-medium-blue">Sign in with ID and PIN</a></li>
          <li class="bullet-lists" id="btnForgotPasswordBullet" style="display: none;"><a href="/Login/AccessRecovery?mode=2" onclick="javascript: LogEvent_ForgotPasswordStart();" class="text-medium-blue" id="forgotPasswordLink">Forgot Password</a>
          </li>
          <li class="bullet-lists" id="btnForgotPinBullet"><a href="/Login/AccessRecovery?mode=1" class="text-medium-blue" id="forgotPinlink">Forgot PIN</a></li>
        </ul>
      </div>
    </div>
  </div>
</form>

Text Content

 
DATE OF BIRTH:
ID:
PIN:

Email
Password

Remember me
SIGN IN

 * Sign in with email
 * Display login details
 * Sign in with ID and PIN
 * Forgot Password
 * Forgot PIN





 
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Should you experience a problem reporting your medical information, please
contact your clinic directly. For medical emergencies, please contact 911 or
your local emergency telephone number.
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