www.opticareconnect.com
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52.17.119.105
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Submitted URL: http://opticareconnect.com/
Effective URL: https://www.opticareconnect.com/
Submission: On December 07 via api from IN — Scanned from DE
Effective URL: https://www.opticareconnect.com/
Submission: On December 07 via api from IN — Scanned from DE
Form analysis 1 forms found in the DOM
Name: wf-form-Website-Inquiry — GET
<form id="wf-form-Website-Inquiry" name="wf-form-Website-Inquiry" data-name="Website Inquiry" method="get" class="form" data-wf-page-id="650e2c4925167461fbb34d7b" data-wf-element-id="737c3c4e-32e3-8781-4f51-0756e28f24c7" aria-label="Website Inquiry">
<div class="w-row">
<div class="lft-align w-col w-col-6"><label for="name" class="light-label">Name</label><input type="text" class="dark-field w-input" maxlength="256" name="name" data-name="Name" placeholder="" id="name"><label for="Phone"
class="light-label">Phone</label><input type="text" class="dark-field w-input" maxlength="256" name="Phone" data-name="Phone" placeholder="" id="Phone"></div>
<div class="lft-align w-col w-col-6"><label for="Company-Name" class="light-label">Company Name</label><input type="text" class="dark-field w-input" maxlength="256" name="Company-Name" data-name="Company Name" placeholder="" id="Company-Name"
required=""><label for="Email-3" class="light-label">Email</label><input type="email" class="dark-field w-input" maxlength="256" name="Email" data-name="Email" placeholder="" id="Email-3" required=""></div>
</div><label for="message" class="light-label lft-align">Message</label><textarea placeholder="" maxlength="5000" id="message" name="message" data-name="message" class="dark-field w-input"></textarea><input type="submit" value="Submit"
data-wait="Please wait..." class="primary-btn w-button">
</form>Text Content
Client Login OPTIMIZED CARE, EMPOWERING BUSINESS OptiCare Connect provides on-site injury response management solutions. Our full site is currently under construction and we hope to share it with you soon. In the meantime, please call or fill out our contact form and we'll get back to you as soon as we can. CONTACT US TODAY! CALL 855.844.6767 OR FILL OUT THE FORM BELOW. NamePhone Company NameEmail Message Thank you! Your submission has been received! Oops! Something went wrong while submitting the form.