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Submitted URL: https://link.email.2nd.md/ls/click?upn=uOJ7-2BsUDGWgk-2BZMwi7K5s1Jp12NnIbq8b2dDKAF4iZojQrahpQLYcvZt3ySohlyOnQptMkUixnM9QuE...
Effective URL: https://www.2nd.md/activate/step1/santander
Submission: On November 08 via api from ES — Scanned from ES
Effective URL: https://www.2nd.md/activate/step1/santander
Submission: On November 08 via api from ES — Scanned from ES
Form analysis 1 forms found in the DOM
POST /activate/step2/santander
<form id="activation" method="post" action="/activate/step2/santander" novalidate="">
<div id="activationMainRowDiv" class="d-block row">
<div class="body-container col container">
<div class="row">
<div class="col-12">
<div class="form-group">
<div class="d-flex align-items-center">
<label class="pl-0 form-label text-black montserrat bold-font">First Name</label>
<button type="button" class="btn btn-transparent btn-icon-info bold pl-2 mb-2 " aria-describedby="sr-covered-members" aria-label="First Name Tooltip" data-toggle="tooltip" data-html="true" trigger="hover focus" title=""
data-original-title="<span style='min-width: 5rem'>Covered members, please enter your first name as it appears in your organization's records.</span>">
<i class="fa fa-info-circle text-black"></i>
</button>
</div>
<div id="invalidFirstName" role="alert" tabindex="-1" aria-controls="first" class="invalid-feedback montserrat w-100">Please provide your first name</div>
<input type="text" id="first" name="first" data-click-countable="true" data-error-id="#invalidFirstName" class="form-control col-sm montserrat" value="" aria-label="first name input" autocomplete="given-name" required="">
</div>
</div>
<div class="col-12">
<div class="form-group">
<div class="d-flex align-items-center">
<label class="pl-0 form-label text-black montserrat bold-font">Last Name</label>
<button type="button" class="btn btn-transparent btn-icon-info bold pl-2 mb-2" aria-describedby="sr-covered-members" aria-label="Last Name Tooltip" data-toggle="tooltip" data-html="true" trigger="hover focus" title=""
data-original-title="<span style='min-width: 5rem'>Covered members, please enter your last name as it appears in your organization's records.</span>">
<i class="fa fa-info-circle text-black"></i>
</button>
</div>
<div id="invalidLastName" role="alert" tabindex="-1" aria-controls="last" class="invalid-feedback montserrat w-100">Please provide your last name</div>
<input type="text" id="last" name="last" data-click-countable="true" data-error-id="#invalidLastName" class="form-control col-sm montserrat" value="" aria-label="last name input" autocomplete="family-name" required="">
</div>
</div>
<div class="col-12">
<div class="form-group form-for-date flex-wrap flex-lg-nowrap d-flex d-sm-block flex-column">
<div class="d-flex align-items-center">
<label class="pl-0 form-label text-black montserrat bold-font">Date Of Birth</label>
</div>
<div id="invalidDateSelect" role="alert" tabindex="-1" aria-controls="month day year" class="invalid-feedback montserrat w-100">Please provide a valid birth date</div>
<div class="d-flex col-sm p-0">
<div id="divMonth" class="col-5 px-0 pr-1 selectable">
<label for="month" class="sr-only sr-only-focusable ">Month</label>
<select name="month" data-click-countable="true" data-error-id="#invalidDateSelect" id="month" class="form-control theSelect montserrat bold" required="">
<option aria-label="Select month of birth" value="">Month</option>
<option value="1" aria-label="January">January</option>
<option value="2" aria-label="February">February</option>
<option value="3" aria-label="March">March</option>
<option value="4" aria-label="April">April</option>
<option value="5" aria-label="May">May</option>
<option value="6" aria-label="June">June</option>
<option value="7" aria-label="July">July</option>
<option value="8" aria-label="August">August</option>
<option value="9" aria-label="September">September</option>
<option value="10" aria-label="October">October</option>
<option value="11" aria-label="November">November</option>
<option value="12" aria-label="December">December</option>
</select>
<div id="selectMonth"></div>
</div>
<div id="divDay" class="col-3 px-0 pr-1 selectable">
<label for="day" class="sr-only sr-only-focusable ">Day</label>
<select id="day" data-click-countable="true" data-error-id="#invalidDateSelect" name="day" class="form-control theSelect montserrat bold" required="">
<option aria-label="Select date of birth" value="">Day</option>
<option aria-label="1" value="1">1</option>
<option aria-label="2" value="2">2</option>
<option aria-label="3" value="3">3</option>
<option aria-label="4" value="4">4</option>
<option aria-label="5" value="5">5</option>
<option aria-label="6" value="6">6</option>
<option aria-label="7" value="7">7</option>
<option aria-label="8" value="8">8</option>
<option aria-label="9" value="9">9</option>
<option aria-label="10" value="10">10</option>
<option aria-label="11" value="11">11</option>
<option aria-label="12" value="12">12</option>
<option aria-label="13" value="13">13</option>
<option aria-label="14" value="14">14</option>
<option aria-label="15" value="15">15</option>
<option aria-label="16" value="16">16</option>
<option aria-label="17" value="17">17</option>
<option aria-label="18" value="18">18</option>
<option aria-label="19" value="19">19</option>
<option aria-label="20" value="20">20</option>
<option aria-label="21" value="21">21</option>
<option aria-label="22" value="22">22</option>
<option aria-label="23" value="23">23</option>
<option aria-label="24" value="24">24</option>
<option aria-label="25" value="25">25</option>
<option aria-label="26" value="26">26</option>
<option aria-label="27" value="27">27</option>
<option aria-label="28" value="28">28</option>
<option aria-label="29" value="29">29</option>
<option aria-label="30" value="30">30</option>
<option aria-label="31" value="31">31</option>
</select>
<div id="selectDay"></div>
</div>
<div id="divYear" class="col-4 px-0 selectable">
<label for="year" class="sr-only sr-only-focusable ">Year</label>
<select id="year" data-click-countable="true" data-error-id="#invalidDateSelect" name="year" class="form-control theSelect montserrat bold" required="">
<option aria-label="Select year of birth" value="">Year</option>
<option aria-label="2023" value="2023">2023</option>
<option aria-label="2022" value="2022">2022</option>
<option aria-label="2021" value="2021">2021</option>
<option aria-label="2020" value="2020">2020</option>
<option aria-label="2019" value="2019">2019</option>
<option aria-label="2018" value="2018">2018</option>
<option aria-label="2017" value="2017">2017</option>
<option aria-label="2016" value="2016">2016</option>
<option aria-label="2015" value="2015">2015</option>
<option aria-label="2014" value="2014">2014</option>
<option aria-label="2013" value="2013">2013</option>
<option aria-label="2012" value="2012">2012</option>
<option aria-label="2011" value="2011">2011</option>
<option aria-label="2010" value="2010">2010</option>
<option aria-label="2009" value="2009">2009</option>
<option aria-label="2008" value="2008">2008</option>
<option aria-label="2007" value="2007">2007</option>
<option aria-label="2006" value="2006">2006</option>
<option aria-label="2005" value="2005">2005</option>
<option aria-label="2004" value="2004">2004</option>
<option aria-label="2003" value="2003">2003</option>
<option aria-label="2002" value="2002">2002</option>
<option aria-label="2001" value="2001">2001</option>
<option aria-label="2000" value="2000">2000</option>
<option aria-label="1999" value="1999">1999</option>
<option aria-label="1998" value="1998">1998</option>
<option aria-label="1997" value="1997">1997</option>
<option aria-label="1996" value="1996">1996</option>
<option aria-label="1995" value="1995">1995</option>
<option aria-label="1994" value="1994">1994</option>
<option aria-label="1993" value="1993">1993</option>
<option aria-label="1992" value="1992">1992</option>
<option aria-label="1991" value="1991">1991</option>
<option aria-label="1990" value="1990">1990</option>
<option aria-label="1989" value="1989">1989</option>
<option aria-label="1988" value="1988">1988</option>
<option aria-label="1987" value="1987">1987</option>
<option aria-label="1986" value="1986">1986</option>
<option aria-label="1985" value="1985">1985</option>
<option aria-label="1984" value="1984">1984</option>
<option aria-label="1983" value="1983">1983</option>
<option aria-label="1982" value="1982">1982</option>
<option aria-label="1981" value="1981">1981</option>
<option aria-label="1980" value="1980">1980</option>
<option aria-label="1979" value="1979">1979</option>
<option aria-label="1978" value="1978">1978</option>
<option aria-label="1977" value="1977">1977</option>
<option aria-label="1976" value="1976">1976</option>
<option aria-label="1975" value="1975">1975</option>
<option aria-label="1974" value="1974">1974</option>
<option aria-label="1973" value="1973">1973</option>
<option aria-label="1972" value="1972">1972</option>
<option aria-label="1971" value="1971">1971</option>
<option aria-label="1970" value="1970">1970</option>
<option aria-label="1969" value="1969">1969</option>
<option aria-label="1968" value="1968">1968</option>
<option aria-label="1967" value="1967">1967</option>
<option aria-label="1966" value="1966">1966</option>
<option aria-label="1965" value="1965">1965</option>
<option aria-label="1964" value="1964">1964</option>
<option aria-label="1963" value="1963">1963</option>
<option aria-label="1962" value="1962">1962</option>
<option aria-label="1961" value="1961">1961</option>
<option aria-label="1960" value="1960">1960</option>
<option aria-label="1959" value="1959">1959</option>
<option aria-label="1958" value="1958">1958</option>
<option aria-label="1957" value="1957">1957</option>
<option aria-label="1956" value="1956">1956</option>
<option aria-label="1955" value="1955">1955</option>
<option aria-label="1954" value="1954">1954</option>
<option aria-label="1953" value="1953">1953</option>
<option aria-label="1952" value="1952">1952</option>
<option aria-label="1951" value="1951">1951</option>
<option aria-label="1950" value="1950">1950</option>
<option aria-label="1949" value="1949">1949</option>
<option aria-label="1948" value="1948">1948</option>
<option aria-label="1947" value="1947">1947</option>
<option aria-label="1946" value="1946">1946</option>
<option aria-label="1945" value="1945">1945</option>
<option aria-label="1944" value="1944">1944</option>
<option aria-label="1943" value="1943">1943</option>
<option aria-label="1942" value="1942">1942</option>
<option aria-label="1941" value="1941">1941</option>
<option aria-label="1940" value="1940">1940</option>
<option aria-label="1939" value="1939">1939</option>
<option aria-label="1938" value="1938">1938</option>
<option aria-label="1937" value="1937">1937</option>
<option aria-label="1936" value="1936">1936</option>
<option aria-label="1935" value="1935">1935</option>
<option aria-label="1934" value="1934">1934</option>
<option aria-label="1933" value="1933">1933</option>
<option aria-label="1932" value="1932">1932</option>
<option aria-label="1931" value="1931">1931</option>
<option aria-label="1930" value="1930">1930</option>
<option aria-label="1929" value="1929">1929</option>
<option aria-label="1928" value="1928">1928</option>
<option aria-label="1927" value="1927">1927</option>
<option aria-label="1926" value="1926">1926</option>
<option aria-label="1925" value="1925">1925</option>
<option aria-label="1924" value="1924">1924</option>
<option aria-label="1923" value="1923">1923</option>
</select>
<div id="selectYear"></div>
</div>
</div>
</div>
</div>
<div class="col-12">
<input id="corporate_id" name="corporate_id" type="hidden" value="4454">
<div id="activationRecaptchaContainer" class="form-group flex-wrap" style="display:none" data-recaptcha-key="activation.fail.cnt.20018233172.64.238.118" data-show-recaptcha="" data-fail-count="0">
<label for="activationRecaptcha" class="pl-0 form-label text-black montserrat bold-font"></label>
<div id="activationRecaptchaAlert" tabindex="-1" aria-atomic="true" role="alert" class="invalid-feedback">Please complete the reCAPTCHA verification. </div>
<div id="activationRecaptcha" data-sitekey="6Ld1WKUUAAAAALhGWVPgS008F545wwVDGXF9r_sX"></div>
</div>
</div>
<input type="hidden" name="data" value="{"short":"santander","ci_csrf_token":"d3bf02d973b82b4de3252b940feae091"}"
data-form-data="{"short":"santander","ci_csrf_token":"d3bf02d973b82b4de3252b940feae091"}">
<input type="hidden" name="l_google_client_id" value="">
<input type="hidden" name="client_comp" id="client_comp" value="4454">
<input type="hidden" name="client_obf_email" id="client_obf_email" value="">
<div class="col-12">
<div class="form-group pt-0 pb-1 py-md-0 m-0 text-center">
<button id="nextStep" type="button" aria-label="next step" class="btn w-75 mx-auto bold steps mr-1">Next Step</button>
</div>
</div>
<div class="col-12 pt-3 pb-1 pt-md-2 text-center">
<span class="text-dark">Already have an account? </span> <a href="https://www.2nd.md/login" class="text-dark text-underline">Sign in</a>
</div>
<div class="col-12 py-0 pt-md-2 text-center">
<p class="normal-font mb-0">Step 1 of 3</p>
<a href="#ot-sdk-btn" id="ot-sdk-btn" class="ot-sdk-show-settings px-3 py-0 text-dark" role="button">Manage Cookies</a>
</div>
<div class="col-12 py-1 pt-md-0">
<p class="mb-0 text-dark-gray lato normal-font text-center"> <i class="fas fa-lock"></i> Data will be sent and processed securely<br> SSL encrypted and SOC2 attested</p>
</div>
</div>
</div>
</div>
</form>Text Content
Members: Phone Number 1.866.269.3534 ACTIVATE LOGIN * ABOUT * SERVICES * TESTIMONIALS * WEBINARS * CONTACT Members: Phone Number 1.866.269.3534 Doctors: Phone Number 1.281.990.3673 Business Relations: Phone Number 1.866.410.8650 ACTIVATE LOGIN LOGIN Login ACTIVATE VERIFY COVERAGE AND CREATE ACCOUNT Your sponsoring organization offers 2nd.MD as a covered benefit at no cost to you. Need help registering? Call us at 8662693534 × First Name Please provide your first name Last Name Please provide your last name Date Of Birth Please provide a valid birth date Month Month January February March April May June July August September October November December Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Year 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 Please complete the reCAPTCHA verification. Next Step Already have an account? 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