www.bch.org.au
Open in
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2606:4700:3032::ac43:d74a
Public Scan
Submitted URL: https://www.bch.org.au/network/members/profile?UserKey=3cdc68a2-0191-412e-a8ac-2427b4c58e5c
Effective URL: https://www.bch.org.au/login?ReturnUrl=https%3a%2f%2fwww.bch.org.au%2fnetwork%2fmembers%2fprofile%3fUserKey%3d3cdc68a2-...
Submission Tags: falconsandbox
Submission: On December 21 via api from US — Scanned from DE
Effective URL: https://www.bch.org.au/login?ReturnUrl=https%3a%2f%2fwww.bch.org.au%2fnetwork%2fmembers%2fprofile%3fUserKey%3d3cdc68a2-...
Submission Tags: falconsandbox
Submission: On December 21 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST ./login?ReturnUrl=https%3a%2f%2fwww.bch.org.au%2fnetwork%2fmembers%2fprofile%3fUserKey%3d3cdc68a2-0191-412e-a8ac-2427b4c58e5c
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<script type="text/javascript">
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<div id="searchColumn" class="pull-right">
<div id="MPSearchBlock" role="search">
<script type="text/javascript">
System.import('Common/SearchBox.js').then(function() {
if ('True' == 'True') {
$('#SearchControl_SearchButton').click(function() {
$('#SearchControl_hiddenSearchButton').click();
});
$('#SearchControl_SearchOptions').click(function(e) {
e.stopPropagation();
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$('#SearchControl_SearchBoxToggle').addClass('open');
e.stopPropagation();
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$('#SearchControl_SearchTerm').focus(function(e) {
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e.stopPropagation();
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$('#SearchControl_EndDate').hide();
$('#SearchControl_StartDate').hide();
$('#SearchControl_SearchTerm').focus(function() {
$('#SearchControl_SearchOptions').show();
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$('#SearchControl_DateRangeDDL').change(function() {
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$('#SearchControl_EndDate').hide();
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$('#SearchControl_StartDate').hide();
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$('#SearchControl_EndDate').show();
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$('#SearchControl_SearchInputs').hl_ui_common_searchBox({
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inputId: 'SearchControl_SearchTerm',
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$('#SearchControl_SearchTerm').focus();
$('#SearchToggleIcon').hide();
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$('#SearchToggleIcon').show();
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});
$('#SearchControl_DateRangeDDLOld').change(function() {
if ($('#SearchControl_DateRangeDDLOld').find(":selected").text() == 'on this day') {
$('#SearchControl_EndDateOld').hide();
$('#SearchControl_EndDateOld').val("");
} else {
$('#SearchControl_EndDateOld').show();
}
});
}
$('#SearchControl_SearchInputsOld').hl_ui_common_searchBox({
controlId: 'SearchControl_SearchInputsOld',
inputId: 'SearchControl_SearchTermOld',
buttonId: 'SearchControl_hiddenSearchButtonOld'
});
}
});
</script>
<button id="SearchToggleIcon" type="button" class="btn btn-default" style="display: none;" role="button" aria-label="searchToggle">
<span class="glyphicon glyphicon-search" style="vertical-align: middle"></span>
</button>
<div id="SearchControl_newSearchBox" class="">
<div id="SearchControl_SearchInputs" class="SearchInputs">
<div id="SearchControl_WholeSearch" onkeypress="javascript:return WebForm_FireDefaultButton(event, 'SearchControl_hiddenSearchButton')">
<div class="input-group" style="vertical-align: middle">
<input name="ctl00$SearchControl$SearchTerm" type="text" id="SearchControl_SearchTerm" class="form-control" autocomplete="off" aria-label="search box" placeholder="search" title="search">
<div id="SearchControl_SearchBoxToggle" class="input-group-btn search-box-toggle">
<button id="SearchControl_OptionsButton" type="button" style="display: none;" class="btn btn-default dropdown-toggle" data-toggle="dropdown" aria-label="search options">
<span class="caret"></span>
<span class="sr-only">Search Options</span>
</button>
<button id="SearchControl_SearchButton" type="button" class="btn btn-default " role="button" aria-label="search">
<span class="glyphicon glyphicon-search" style="vertical-align: middle"></span>
</button>
<ul class="dropdown-menu pull-right" role="menu">
<li>
</li>
</ul>
</div>
<input type="submit" name="ctl00$SearchControl$hiddenSearchButton" value=""
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$SearchControl$hiddenSearchButton", "", true, "", "", false, false))"
id="SearchControl_hiddenSearchButton" style="display: none;">
</div>
</div>
</div>
</div>
</div>
</div>
<a id="givenow" href="https://www.givenow.com.au/bch"><img class="img-responsive" style="display: block; width: 220px; margin: 3px auto auto auto;" alt="givenow-button-wide-rectangle-light.png" src="https://higherlogicdownload.s3.amazonaws.com/BCH/1f735a99-3313-4d03-adf5-fe639fd9f118/UploadedImages/givenow-button-wide-rectangle-light-small.png" caption="false"></a>
</div>
</div>
</div>
</nav>
</div>
<div class="MenuBarUnderline navbar-default">
<ul class="nav navbar-nav">
<div class="nav-close" style="display:none;">×</div>
<li><a href="/covid-19"><span>Coronavirus (COVID-19)</span></a></li>
<li class="dropdown"><a href="/about" class="dropdown-toggle" data-toggle="dropdown"><span>About</span> <strong class="caret"></strong></a>
<ul class="dropdown-menu">
<li><a href="/about/about-us">About Us</a></li>
<li><a href="/about/agm2021">Annual General Meeting 2021</a></li>
<li><a href="/about/board">Board and Constitution</a></li>
<li><a href="/about/quality">Quality & Safety</a></li>
<li><a href="/about/publications">Publications</a></li>
<li><a href="/about/privacy">Privacy</a></li>
</ul>
</li>
<li class="dropdown"><a href="/services" class="dropdown-toggle" data-toggle="dropdown"><span>Services</span> <strong class="caret"></strong></a>
<ul class="dropdown-menu">
<li><a href="/services/our-services-overview">Overview</a></li>
<li class="dropdown-submenu"><a href="/services/all-services">All Services <strong class="caret"></strong></a>
<ul class="dropdown-submenu">
<li><a href="/services/all-services/ndis">National Disability Insurance Scheme</a></li>
<li><a href="/services/all-services/homecare">Home Care</a></li>
<li><a href="/services/all-services/adult-aged-care">Adult & Aged Care Services</a></li>
<li><a href="/services/all-services/child-services">Child Services</a></li>
<li><a href="/services/all-services/youth-services">Youth Services</a></li>
<li class="dropdown-submenu"><a href="/services/all-services/specialist-programs">Specialist Services <strong class="caret"></strong></a>
<ul class="dropdown-submenu">
<li class="dropdown-submenu"><a href="/services/all-services/specialist-programs/dental">Dental <strong class="caret"></strong></a>
<ul class="dropdown-submenu">
<li><a href="/services/all-services/specialist-programs/dental/public-fees">Dental - Public Fees</a></li>
<li><a href="/services/all-services/specialist-programs/dental/private-health-insurance">Dental - Private Health Insurance</a></li>
</ul>
</li>
</ul>
</li>
<li><a href="/services/all-services/telehealth">Telehealth</a></li>
</ul>
</li>
<li><a href="/services/fees-2019">Fees</a></li>
<li><a href="/services/intake256">Health Professional Referral</a></li>
<li><a href="/services/referral">Self Referral</a></li>
</ul>
</li>
<li class="dropdown"><a href="/bchgp" class="dropdown-toggle" data-toggle="dropdown"><span>General Practice</span> <strong class="caret"></strong></a>
<ul class="dropdown-menu">
<li><a href="/bchgp/about">About</a></li>
<li><a href="/bchgp/services">Our Services</a></li>
<li><a href="/bchgp/our-staff">Our Staff</a></li>
<li><a href="/bchgp/fees-and-charges">Fees & Charges</a></li>
<li><a href="/bchgp/contact-us">Contact Us</a></li>
<li><a href="/bchgp/book-online">Book Online</a></li>
</ul>
</li>
<li class="dropdown"><a href="/connected-communities" class="dropdown-toggle" data-toggle="dropdown"><span>Connected Communities</span> <strong class="caret"></strong></a>
<ul class="dropdown-menu">
<li class="dropdown-submenu"><a href="/connected-communities/healthy">Healthy Programs <strong class="caret"></strong></a>
<ul class="dropdown-submenu">
<li><a href="/connected-communities/healthy/achievement-program">Achievement Program</a></li>
<li><a href="/connected-communities/healthy/active-travel">Active Travel</a></li>
<li><a href="/connected-communities/healthy/active-women-girls">Active Women and Girls</a></li>
<li><a href="/connected-communities/healthy/healthier-eating">Healthier Eating</a></li>
<li><a href="/connected-communities/healthy/infant-program">INFANT Program</a></li>
<li><a href="/connected-communities/healthy/prevention-of-violence">Prevention of Violence Against Women</a></li>
<li><a href="/connected-communities/healthy/healthy-places">Advocating for Healthy Places</a></li>
</ul>
</li>
<li class="dropdown-submenu"><a href="/connected-communities/community-participation">Community Participation <strong class="caret"></strong></a>
<ul class="dropdown-submenu">
<li><a href="/connected-communities/community-participation/community-advisory-group">Community Advisory Group</a></li>
</ul>
</li>
</ul>
</li>
<li><a href="/projects"><span>Capital Works Projects</span></a></li>
<li class="dropdown"><a href="/get-involved" class="dropdown-toggle" data-toggle="dropdown"><span>Support Us</span> <strong class="caret"></strong></a>
<ul class="dropdown-menu">
<li><a href="/get-involved/become-member">Become a Member</a></li>
<li class="dropdown-submenu"><a href="/get-involved/ways-to-give">Ways to Give <strong class="caret"></strong></a>
<ul class="dropdown-submenu">
<li><a href="/get-involved/ways-to-give/donate">Donate</a></li>
<li><a href="/get-involved/ways-to-give/gifts-in-wills">Gifts in Wills</a></li>
<li><a href="/get-involved/ways-to-give/fundraise">Fundraise</a></li>
<li><a href="/get-involved/ways-to-give/donors">Recent Donors</a></li>
<li><a href="/get-involved/ways-to-give/corporate-partnership">Corporate Partnership</a></li>
</ul>
</li>
<li><a href="/get-involved/feedback">Give Feedback</a></li>
</ul>
</li>
<li><a href="/communities"><span>Portal</span></a></li>
<li class="dropdown"><a href="/work" class="dropdown-toggle" data-toggle="dropdown"><span>Careers & Volunteers</span> <strong class="caret"></strong></a>
<ul class="dropdown-menu">
<li><a href="/work/careers">Positions Available</a></li>
<li><a href="/work/students">Student Placements</a></li>
<li><a href="/work/volunteer">Volunteer</a></li>
</ul>
</li>
<li><a href="/contactus"><span>Contact</span></a></li>
</ul>
</div>
</div>
</div>
</div>
</div>
<div id="MPOuter" class="row siteFrame " style="font-size: 14px;">
<div id="ContentColumn" class="col-md-12">
<!--content-->
<div id="BreadCrumb" class="BreadCrumb">
</div>
<div id="MPContentArea" class="MPContentArea" role="main">
<div id="MPInnerPageBanner">
<h1 id="PageTitleH1" qa-attribute="PageTitleH1"> Login or Register </h1>
</div>
<div id="FlashMessageContainer">
</div>
<div class="feature-preview-row row-wide">
</div>
<div id="MainCopy_ContentWrapper">
<div class="row row-wide clearfix ">
<div class="col-md-4 section1">
<div class="ContentUserControl">
<div class="row">
<div class="login-panel">
<span id="MainCopy_ctl02_LoginErrorMessage" class="ErrorMessage"></span>
</div>
</div>
<div id="MainCopy_ctl02_loginDiv" class="login-panel" onkeypress="javascript:return WebForm_FireDefaultButton(event, 'MainCopy_ctl02_LoginRecaptchaButton')">
<div class="panel panel-default">
<div class="panel-heading">
<h3 id="MainCopy_ctl02_LoginSectionH2" class="panel-title"><strong>Members - Login here</strong></h3>
</div>
<div class="panel-body">
<div id="MainCopy_ctl02_Div1">
<div class="row form-group">
<div class="col-md-5">
<label for="MainCopy_ctl02_UserLogin" id="MainCopy_ctl02_LoginUserNameLabel">Email</label>
</div>
<div class="col-md-7">
<input name="ctl00$MainCopy$ctl02$UserLogin" type="text" id="MainCopy_ctl02_UserLogin" class="form-control">
</div>
</div>
</div>
<div id="MainCopy_ctl02_Div2">
<div class="row form-group">
<div class="col-md-5">
<label for="MainCopy_ctl02_UserPass" id="MainCopy_ctl02_LoginPasswordLabel">Password</label>
</div>
<div class="col-md-7">
<input name="ctl00$MainCopy$ctl02$UserPass" type="password" id="MainCopy_ctl02_UserPass" class="form-control" autocomplete="off">
</div>
</div>
</div>
<div id="MainCopy_ctl02_Div3" class="row form-group">
<div class="col-md-12">
<a id="MainCopy_ctl02_ForgotPassword" href="HigherLogic/Security/ResetPassword.aspx">Did You Forget Your Password?</a>
</div>
</div>
<div id="MainCopy_ctl02_Div4" class="row form-group">
<div class="col-md-12">
<span class="form-control"><input id="MainCopy_ctl02_Remember" type="checkbox" name="ctl00$MainCopy$ctl02$Remember"><label for="MainCopy_ctl02_Remember"> Stay signed in</label></span>
</div>
</div>
<div class="row">
<div class="col-md-12">
<input type="submit" name="ctl00$MainCopy$ctl02$LoginRecaptchaButton" value="Login" id="MainCopy_ctl02_LoginRecaptchaButton" class="btn btn-primary">
</div>
</div>
</div>
</div>
</div>
<div id="MainCopy_ctl02_pnlSignUp" class="login-panel" onkeypress="javascript:return WebForm_FireDefaultButton(event, 'MainCopy_ctl02_CreateAccountButton')">
</div>
<script type="text/javascript">
// Used to insert javascript for this page
//-->
</script>
</div>
</div>
<div class="col-md-8 section2">
<div class="ContentUserControl">
<div class="row">
<div class="login-panel">
<span id="MainCopy_ctl05_LoginErrorMessage" class="ErrorMessage"></span>
</div>
</div>
<div id="MainCopy_ctl05_pnlSignUp" class="login-panel" onkeypress="javascript:return WebForm_FireDefaultButton(event, 'MainCopy_ctl05_CreateAccountButton')">
<div id="MainCopy_ctl05_SignupSection" class="panel panel-default">
<div class="panel-heading">
<h3 class="panel-title"><strong>Not registered yet? Create an account</strong></h3>
</div>
<div class="panel-body">
<div class="row form-group required" aria-required="true">
<div class="col-md-4">
<label for="MainCopy_ctl05_EmailAddress" id="MainCopy_ctl05_EmailAddressLabel" class="control-label" style="font-weight:bold;">Email</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$EmailAddress" type="text" maxlength="100" id="MainCopy_ctl05_EmailAddress" class="form-control" aria-required="true" aria-describedby="EmailAddressLabel">
<span id="MainCopy_ctl05_EmailAddressRegValidator" class="invalidInputLabel" style="display:none;">Invalid Email Address </span>
</div>
</div>
<div id="FirstNameRow" class="row form-group required" aria-required="true">
<div class="col-md-4">
<label for="MainCopy_ctl05_FirstName" id="MainCopy_ctl05_FirstNameLabel" class="control-label" style="font-weight:bold;">First Name</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$FirstName" type="text" maxlength="50" id="MainCopy_ctl05_FirstName" class="form-control" aria-required="true">
</div>
</div>
<div id="LastNameRow" class="row form-group required">
<div class="col-md-4">
<label for="MainCopy_ctl05_LastName" id="MainCopy_ctl05_LastNameLabel" class="control-label" style="font-weight:bold;">Last Name</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$LastName" type="text" maxlength="50" id="MainCopy_ctl05_LastName" class="form-control" aria-required="true">
</div>
</div>
<div id="MainCopy_ctl05_divJobTitle" class="row form-group ">
<div class="col-md-4">
<label for="MainCopy_ctl05_JobTitle" id="MainCopy_ctl05_JobTitleLabel" class="control-label" style="font-weight:bold;">Job Title</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$JobTitle" type="text" maxlength="50" id="MainCopy_ctl05_JobTitle" class="form-control">
</div>
</div>
<div id="MainCopy_ctl05_divCompany" class="row form-group required">
<div class="col-md-4">
<label for="MainCopy_ctl05_CompanyName" id="MainCopy_ctl05_CompanyNameLabel" class="control-label" style="font-weight:bold;">Company Name</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$CompanyName" type="text" maxlength="50" id="MainCopy_ctl05_CompanyName" class="form-control">
</div>
</div>
<div id="MainCopy_ctl05_divAddress1" class="row form-group ">
<div class="col-md-4">
<label for="MainCopy_ctl05_Address1" id="MainCopy_ctl05_Address1Label" class="control-label" style="font-weight:bold;">Address 1</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$Address1" type="text" maxlength="50" id="MainCopy_ctl05_Address1" class="form-control">
</div>
</div>
<div id="MainCopy_ctl05_divAddress2" class="row form-group ">
<div class="col-md-4">
<label for="MainCopy_ctl05_Address2" id="MainCopy_ctl05_Address2Label" class="control-label" style="font-weight:bold;">Address 2</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$Address2" type="text" maxlength="50" id="MainCopy_ctl05_Address2" class="form-control">
</div>
</div>
<div id="MainCopy_ctl05_divAddress3" class="row form-group ">
<div class="col-md-4">
<label for="MainCopy_ctl05_Address3" id="MainCopy_ctl05_Address3Label" class="control-label" style="font-weight:bold;">Address 3</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$Address3" type="text" maxlength="50" id="MainCopy_ctl05_Address3" class="form-control">
</div>
</div>
<div id="MainCopy_ctl05_divCity" class="row form-group ">
<div class="col-md-4">
<label for="MainCopy_ctl05_City" id="MainCopy_ctl05_CityLabel" class="control-label" style="font-weight:bold;">City</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$City" type="text" maxlength="50" id="MainCopy_ctl05_City" class="form-control">
</div>
</div>
<div id="MainCopy_ctl05_divCountryStateProvinceCode">
<div id="MainCopy_ctl05_dsCountryStateProvinceList_updStateListPanel">
<div id="MainCopy_ctl05_dsCountryStateProvinceList_CountryRow" class="row form-group ">
<label id="lblCountry" for="MainCopy_ctl05_dsCountryStateProvinceList_ddlCountry" class="control-label col-md-4 ">Country</label>
<div class="col-md-8 ">
<select name="ctl00$MainCopy$ctl05$dsCountryStateProvinceList$ddlCountry" onchange="javascript:setTimeout('__doPostBack(\'ctl00$MainCopy$ctl05$dsCountryStateProvinceList$ddlCountry\',\'\')', 0)"
id="MainCopy_ctl05_dsCountryStateProvinceList_ddlCountry" title="Select a Country" class="form-control">
<option selected="selected" value="">(Country)</option>
<option value="US">United States</option>
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="CV">Cabo Verde</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo, The Democratic Republic of the</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte D'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Islands</option>
<option value="VA">Holy See (Vatican City State)</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran, Islamic Republic of</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea, Democratic People's Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="XK">Kosovo</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MK">Macedonia, The Former Yugoslav Republic of</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia, Federated States of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestine, State of</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and The Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and The South Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela, Bolivarian Republic of</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands, British</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
</div>
</div>
<div id="MainCopy_ctl05_dsCountryStateProvinceList_StateProvinceRow" class="row form-group ">
<label id="lblState" for="MainCopy_ctl05_dsCountryStateProvinceList_ddlState" class="control-label col-md-4 ">State/Province</label>
<div class="col-md-8 ">
<select name="ctl00$MainCopy$ctl05$dsCountryStateProvinceList$ddlState" id="MainCopy_ctl05_dsCountryStateProvinceList_ddlState" disabled="disabled" title="Select a State" class="aspNetDisabled form-control">
<option selected="selected" value="">(State/Province)</option>
</select>
</div>
</div>
</div>
</div>
<div id="MainCopy_ctl05_divPC" class="row form-group ">
<div class="col-md-4">
<label for="MainCopy_ctl05_ZipCode" id="MainCopy_ctl05_ZipCodeLabel1" class="control-label" style="font-weight:bold;">Zip/Postal Code</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$ZipCode" type="text" maxlength="50" id="MainCopy_ctl05_ZipCode" class="form-control">
</div>
</div>
<div id="MainCopy_ctl05_divPhone1" class="row form-group ">
<div class="col-md-4">
<label for="MainCopy_ctl05_Phone1" id="MainCopy_ctl05_Phone1Label" class="control-label" style="font-weight:bold;">Work Phone</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$Phone1" type="text" maxlength="50" id="MainCopy_ctl05_Phone1" class="form-control">
</div>
</div>
<div id="MainCopy_ctl05_divPhone2" class="row form-group ">
<div class="col-md-4">
<label for="MainCopy_ctl05_Phone2" id="MainCopy_ctl05_Phone2Label" class="control-label" style="font-weight:bold;">Home Phone</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$Phone2" type="text" maxlength="50" id="MainCopy_ctl05_Phone2" class="form-control">
</div>
</div>
<div id="MainCopy_ctl05_divPhone3" class="row form-group ">
<div class="col-md-4">
<label for="MainCopy_ctl05_Phone3" id="MainCopy_ctl05_Phone3Label" class="control-label" style="font-weight:bold;">Mobile Phone</label>
</div>
<div class="col-md-8">
<input name="ctl00$MainCopy$ctl05$Phone3" type="text" maxlength="50" id="MainCopy_ctl05_Phone3" class="form-control">
</div>
</div>
<div id="MainCopy_ctl05_divDemographics" class="row form-group">
<div class="col-md-12">
<div id="aa346044-eb3b-452e-8aa7-0041160050ac">
</div>
<script>
$(document).ready(function() {
$('.toselectpicker').selectpicker();
});
</script>
</div>
<input type="hidden" name="ctl00$MainCopy$ctl05$hdnDemographicTypes" id="MainCopy_ctl05_hdnDemographicTypes">
</div>
<div id="MainCopy_ctl05_divPasswordPolicy" class="row margin-bottom-large">
<div class="col-md-12">
<span id="MainCopy_ctl05_PasswordPolicyText" class="control-label" style="font-size:Small;"></span>
</div>
</div>
<div id="MainCopy_ctl05_divPassword" class="row form-group required">
<div class="col-md-4">
<label for="MainCopy_ctl05_Password" id="MainCopy_ctl05_PasswordLabel" class="control-label" style="font-weight:bold;">Password</label>
</div>
<div class="col-md-8" id="divPasswordInput">
<input name="ctl00$MainCopy$ctl05$Password" type="password" id="MainCopy_ctl05_Password" maxlength="50" class="form-control" aria-required="true" autocomplete="off">
</div>
</div>
<div id="MainCopy_ctl05_divConfirmPswd" class="row form-group required">
<div class="col-md-4">
<label for="MainCopy_ctl05_ConfirmPassword" id="MainCopy_ctl05_ConfirmPasswordLabel" class="control-label" style="font-weight:bold;">Confirm Password</label>
</div>
<div class="col-md-8" id="divConfirmPswdInput">
<input name="ctl00$MainCopy$ctl05$ConfirmPassword" type="password" id="MainCopy_ctl05_ConfirmPassword" maxlength="50" class="form-control" aria-required="true" autocomplete="off">
</div>
</div>
<div visible="" class="row form-group">
<div class="col-md-12">
<span class="form-control remember-me"><input id="MainCopy_ctl05_Remember2" type="checkbox" name="ctl00$MainCopy$ctl05$Remember2"><label for="MainCopy_ctl05_Remember2">Remember Password?</label></span>
</div>
</div>
<div class="row">
<div class="col-md-12">
<input type="submit" name="ctl00$MainCopy$ctl05$CreateAccountButton" value="Create Account"
onclick="validateAndGrabDemographics();WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$MainCopy$ctl05$CreateAccountButton", "", true, "", "", false, false))"
id="MainCopy_ctl05_CreateAccountButton" class="btn btn-primary" role="button">
</div>
</div>
<div class="row">
<div class="col-md-12 SmallText">
<br>
<label class="control-label invalidInputLabel">*</label>
<label class="control-label">Indicates that the field is required</label>
</div>
</div>
</div>
<script type="text/javascript">
var passPolEnabled = false;
var passPolicy = ["None"];
function ShowFirstNameLastName() {
document.getElementById('FirstNameRow').style.display = 'block';
document.getElementById('LastNameRow').style.display = 'block';
var companySpan = document.getElementById('MainCopy_ctl05_CompanyNameLabel');
var index = companySpan.innerHTML.indexOf('*');
if (index == 0) {
var IsCompanyRequiredFeild = True;
if (!IsCompanyRequiredFeild) companySpan.innerHTML = document.getElementById('MainCopy_ctl05_CompanyNameLabel').innerHTML.substring(1, document.getElementById('MainCopy_ctl05_CompanyNameLabel').innerHTML.length);
}
}
function HideFirstNameLastName() {
document.getElementById('FirstNameRow').style.display = 'none';
document.getElementById('LastNameRow').style.display = 'none';
var companySpan = document.getElementById('MainCopy_ctl05_CompanyNameLabel');
var index = companySpan.innerHTML.indexOf('*');
if (index == -1) {
companySpan.innerHTML = "*" + document.getElementById('MainCopy_ctl05_CompanyNameLabel').innerHTML;
}
}
function uppCaseCount(str) {
var count = 0
for (x = 0; x < str.length; x++) {
if (str.charAt(x) >= 'A' && str.charAt(x) <= 'Z') count++;
}
return count;
}
function numCount(str) {
var count = 0
for (x = 0; x < str.length; x++) {
if (str.charAt(x) >= '0' && str.charAt(x) <= '9') count++;
}
return count;
}
function specCharCount(str) {
var count = 0;
var specialChars = "~!@#$%^&*()_+{}:\"<>?"
for (x = 0; x < str.length; x++) {
for (i = 0; i < specialChars.length; i++) {
if (str[x] == specialChars[i]) count++
}
}
return count;
}
$(document).ready(function() {
$("[id*='Password']").on('keyup', function(e) {
var valid = true;
var newPasswordRequired = "<span class=\"help-block\">New password is required</span>";
var confirmPasswordRequired = "<span class=\"help-block\">Confirm password is required</span>";
var passwordMatchRequired = "<span class=\"help-block\">The confirm new password must match the new password entry</span>";
var conformToPasswordPolicyRequired = "<span class=\"help-block\">New password does not conform to password policy</span>";
var $newPasswordContainer = $("#divPassword");
var $newPasswordInputContainer = $("#divPasswordInput");
var $newPassword = $("input[id*='_Password']");
var $confirmPasswordContainer = $("#divConfirmPswd");
var $confirmPasswordInputContainer = $("#divConfirmPswdInput");
var $confirmPassword = $("input[id*='_ConfirmPassword']");
$newPasswordContainer.removeClass("has-error");
$confirmPasswordContainer.removeClass("has-error");
$(".help-block").remove();
if ($newPassword.val() == "") {
$newPasswordContainer.addClass("has-error");
$newPasswordInputContainer.append(newPasswordRequired);
valid = false;
}
if ($confirmPassword.val() == "") {
$confirmPasswordContainer.addClass("has-error");
$confirmPasswordInputContainer.append(confirmPasswordRequired);
valid = false;
}
if (valid && $confirmPassword.val().toLowerCase() != $newPassword.val().toLowerCase()) {
$confirmPasswordContainer.addClass("has-error");
$confirmPasswordInputContainer.append(passwordMatchRequired);
valid = false;
}
if (passPolEnabled) {
if ($newPassword.val().length > parseInt(passPolicy[0])) {
$newPasswordContainer.addClass("has-error");
$newPasswordInputContainer.append(conformToPasswordPolicyRequired);
valid = false;
} else if ($newPassword.val().length < parseInt(passPolicy[1])) {
$newPasswordContainer.addClass("has-error");
$newPasswordInputContainer.append(conformToPasswordPolicyRequired);
valid = false;
} else if (uppCaseCount($newPassword.val()) < parseInt(passPolicy[2])) {
$newPasswordContainer.addClass("has-error");
$newPasswordInputContainer.append(conformToPasswordPolicyRequired);
valid = false;
} else if (numCount($newPassword.val()) < parseInt(passPolicy[3])) {
$newPasswordContainer.addClass("has-error");
$newPasswordInputContainer.append(conformToPasswordPolicyRequired);
valid = false;
} else if (specCharCount($newPassword.val()) < parseInt(passPolicy[4])) {
$newPasswordContainer.addClass("has-error");
$newPasswordInputContainer.append(conformToPasswordPolicyRequired);
valid = false;
}
}
return valid;
});
});
function validateAndGrabDemographics() {
var demographicTypes = [];
//validate required and grab values
$.each($('#MainCopy_ctl05_divDemographics').find('.demoType'), function() {
var selectValues = $(this).find('select').val();
var freeFormValue = $(this).find('input').length === 1 ? $(this).find('input').val() : '';
//bring up error messages
demographicTypes.push({
"DemographicTypeKey": $(this).data('demographictypekey'),
"DemographicChoices": $.isArray(selectValues) ? selectValues : hl_common_util_stringIsNullOrWhiteSpace(selectValues) ? ["00000000-0000-0000-0000-000000000000"] : [selectValues],
"FreeFormText": encodeURIComponent(freeFormValue)
});
});
$('#MainCopy_ctl05_hdnDemographicTypes').val(JSON.stringify(demographicTypes));
}
function showRequiredDemos(errorDemographicTypeKeys, previousValues) {
//if there were demos that were not filled out that are required, then show error message
$.each(errorDemographicTypeKeys, function(index, value) {
$('#' + value + '-demoRow').find('.error-message').removeClass('hidden');
});
//set values for all demos that were filled out
$.each(previousValues, function(index, value) {
if (value.DemographicChoices.length > 0) {
$('#' + value.DemographicTypeKey + '-select').val(value.DemographicChoices);
}
if (!hl_common_util_stringIsNullOrWhiteSpace(value.FreeFormText)) {
$('#' + value.DemographicTypeKey + '-freeform').val(decodeURIComponent(value.FreeFormText));
}
});
}
</script>
</div>
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<div class="notification notification-info" title="" role="alert"><span class="type-icon info"><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="info-square" class="svg-inline--fa fa-info-square fa-w-14 fa-lg"
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<script charset="utf-8">
$(document).ready(function() {
// Change news posted by name to BCH
$('#MainCopy_ctl04_ucPermission_UserName_lnkProfile').html('Bellarine Community Health');
$('#MainCopy_ctl04_ucPermission_UserName_lnkProfile').contents().unwrap();
});
</script>
</div>
<div class="ContentUserControl">
<script charset="utf-8">
$(document).ready(function() {
if (navigator.userAgent.match(/msie/i) || navigator.userAgent.match(/trident/i)) {
$('.services-table thead th a').addClass('IE');
$('.services-table thead th a').addClass('IE');
}
});
</script>
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<div class="ContentItemHtml">
<div class="HtmlContent">
<div class="nav-background"></div>
</div>
<div class="HtmlFooter"></div>
</div>
<div class="ContentItemHtml">
<div class="HtmlContent">
<div id="accessibility-options">
<h4><a href="#" id="accessibility-toggle" class="transition-ease">Hide <img height="20px" src="https://higherlogicdownload.s3.amazonaws.com/BCH/1f735a99-3313-4d03-adf5-fe639fd9f118/UploadedImages/down-arrow-no-bg.png"></a></h4>
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<div class="skiptranslate goog-te-gadget" dir="ltr" style="">
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