feedback.shift32.com Open in urlscan Pro
2606:4700::6810:d09b  Public Scan

Form analysis
1 forms found in the DOM

POST /builder/pages/97863/submit_form

<form class="contact-form" id="form_contact" data-track="yes" data-track-name="funnel_click" data-track-key="review" data-track-text="Submit Review" data-track-destination="onsite" data-track-context="private_feedback_submitted"
  action="/builder/pages/97863/submit_form" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓"><input type="hidden" name="authenticity_token"
    value="YeSoaiFM7NUszcMtr/zdpmEyjVnxqgAsGgRe7z9yWIYWJAySgvHARTdPJJa65VFFXstgTTps22qV+ys+PW+Q/A==">
  <fieldset>
    <div class="name field text_field" id="field-name">
      <label class="field-label" for="name">Your Name*</label>
      <input type="text" name="name" id="name" value="" class="required" placeholder="Your Name*">
    </div>
    <div class="phone field text_field" id="field-phone">
      <label class="field-label" for="phone">Phone</label>
      <input type="text" name="phone" id="phone" value="" class="plain-phone" placeholder="Phone">
    </div>
    <div class="email field email_field" id="field-email">
      <label class="field-label" for="email">Email*</label>
      <input type="email" name="email" id="email" value="" class="required" placeholder="Email*">
    </div>
    <div class="url field text_field" id="field-url">
      <label class="field-label" for="url">URL</label>
      <input type="text" name="url" id="url" value="" placeholder="URL">
    </div>
    <div class="message field text_area" id="field-message">
      <label class="field-label" for="message">Message</label>
      <textarea name="message" id="message" placeholder="Message"></textarea>
    </div>
    <div class="recaptcha field" id="field-recaptcha">
      <div class="recaptcha-container">
        <div class="g-recaptcha" data-sitekey="6LfVLgkTAAAAABDAapJpBKjW8GbSNq0FW81Y3L_0" id="recaptcha-0">
          <div style="width: 304px; height: 78px;">
            <div><iframe title="reCAPTCHA"
                src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LfVLgkTAAAAABDAapJpBKjW8GbSNq0FW81Y3L_0&amp;co=aHR0cHM6Ly9mZWVkYmFjay5zaGlmdDMyLmNvbTo0NDM.&amp;hl=de&amp;v=nEGwmCAyCoKVn9PSwAGnQWhY&amp;size=normal&amp;cb=jhcdkj41l527"
                width="304" height="78" role="presentation" name="a-ppnqw7yiczkj" frameborder="0" scrolling="no"
                sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
              class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
          </div><iframe style="display: none;"></iframe>
        </div>
      </div>
    </div>
  </fieldset><input type="hidden" name="id" id="id" value="97863">
  <input type="hidden" name="form_type" id="form_type" value="contact">
  <input type="hidden" name="prelude" id="field_prelude_feedback" value="none">
  <div class="footer">
    <input type="submit" name="commit" value="Send Message" class="submit" data-disable-with="Send Message">
  </div>
</form>

Text Content

Strengthen your new patient flow, expand your brand, and protect your
profession!



Would you please share your experience on the difference you understand with
SHIFT32, its team, its systems, and its focus. You will be helping your
profession stay in the hands of the specialist. 

 * I had a good experience.
   I had a good experience.
 * I had a bad experience.
   I had a bad experience.


THANKS FOR VISITING!

Please enjoy the following as a token of thanks for being our customer. (No
review necessary.)

Claim Offer
 * Like Us on Facebook
 * Follow @_SHIFT_32



Thank you. If you have concerns you wish to address in private, please get in
touch. Otherwise, click a link below to add a public review.



Send feedback

×

Thank you! We need your help. Would you share your experience on one of these
sites?

 * Google
   

 * Google
   
 * Facebook
   

If you have concerns you wish to address in private, please get in touch.



×


GOOGLE

If you don’t already have a Google account, you should—use it to read and post
reviews, as well as access other Google products like Gmail.

From our Google listing:

 * If prompted, sign up or log in

 * Leave your rating and feedback

 * Click post to share with others.

Note: This website is not affiliated with or endorsed by Google.

Review us on Google Back
×


FACEBOOK

Facebook lets us stay connected with our customers, fans and friends—and now
lets you review businesses.

From our Facebook page:

 * Log in or sign up if you haven’t already
 * Find the “Recommendations” widget in the body of the page and recommend us
 * Leave additional feedback at the prompt
 * “Like” our page if you want to stay connected with us

Note: This website is not affiliated with or endorsed by Facebook.

Review us on Facebook Back
×

In order to stay on top of our industry we need to ensure that we strive for
100% customer satisfaction. If we fell short, please tell us the details so we
can address your concerns and get better as a company.

Your Name*
Phone
Email*
URL
Message


If you do not wish to address your concerns here and prefer to post a review,
click here.