www.clearviewcancer.com
Open in
urlscan Pro
141.193.213.10
Public Scan
Submitted URL: http://www.ccihsv.com/
Effective URL: https://www.clearviewcancer.com/
Submission: On May 28 via api from US — Scanned from DE
Effective URL: https://www.clearviewcancer.com/
Submission: On May 28 via api from US — Scanned from DE
Form analysis 2 forms found in the DOM
GET https://www.clearviewcancer.com/
<form role="search" method="get" class="jet-search__form" action="https://www.clearviewcancer.com/">
<label class="jet-search__label">
<input type="search" class="jet-search__field" placeholder="Search Clearview Cancer " value="" name="s">
</label>
<button type="submit" class="jet-search__submit" aria-label="submit search"><span class="jet-search__submit-icon jet-blocks-icon"><i aria-hidden="true" class="fas fa-search"></i></span></button>
</form><form>
<div>
<div class="nf-before-form-content"><nf-section>
<div class="nf-form-fields-required">Fields marked with an <span class="ninja-forms-req-symbol">*</span> are required</div>
</nf-section></div>
<div class="nf-form-content ">
<div>
<div class="nf-mp-header">
<div>
</div>
</div>
<div class="nf-mp-body"><nf-rows-wrap>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-300-container" class="nf-field-container textbox-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-300-wrap" class="field-wrap textbox-wrap" data-field-id="300">
<div class="nf-field-label">
<label for="nf-field-300" id="nf-label-field-300" class=""> Full Name <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-300" name="nf-field-300-textbox" autocomplete="on" aria-invalid="false" aria-describedby="nf-error-300" aria-labelledby="nf-label-field-300"
aria-required="true" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-300" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-311-container" class="nf-field-container textbox-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-311-wrap" class="field-wrap textbox-wrap" data-field-id="311">
<div class="nf-field-label">
<label for="nf-field-311" id="nf-label-field-311" class=""> Date of Birth <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-311" name="nf-field-311-textbox" autocomplete="on" aria-invalid="false" aria-describedby="nf-error-311" aria-labelledby="nf-label-field-311"
aria-required="true" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-311" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-309-container" class="nf-field-container html-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-309-wrap" class="field-wrap html-wrap" data-field-id="309">
<div class="nf-field-label">
<label for="nf-field-309" id="nf-label-field-309" class=""> Mailing Address </label>
</div>
<div class="nf-field-element">
<h4>Mailing Address</h4>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-309" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-304-container" class="nf-field-container address-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-304-wrap" class="field-wrap address-wrap" data-field-id="304">
<div class="nf-field-label">
<label for="nf-field-304" id="nf-label-field-304" class=""> Street Address <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-304" name="address" autocomplete="street-address" aria-invalid="false" aria-describedby="nf-error-304" aria-labelledby="nf-label-field-304"
aria-required="true" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-304" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-305-container" class="nf-field-container city-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-305-wrap" class="field-wrap city-wrap" data-field-id="305">
<div class="nf-field-label">
<label for="nf-field-305" id="nf-label-field-305" class=""> City <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-305" name="city" autocomplete="address-level2" aria-invalid="false" aria-describedby="nf-error-305" aria-labelledby="nf-label-field-305"
aria-required="true" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-305" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-306-container" class="nf-field-container liststate-container label-above list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-306-wrap" class="field-wrap liststate-wrap list-wrap list-select-wrap" data-field-id="306">
<div class="nf-field-label">
<label for="nf-field-306" id="nf-label-field-306" class=""> State <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<select id="nf-field-306" name="nf-field-306" aria-invalid="false" aria-describedby="nf-error-306" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-306" aria-required="true" required="">
<option value="" selected="selected">- Select State -</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="DC">Washington DC</option>
<option value="AE">ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST</option>
<option value="AA">ARMED FORCES AMERICA (EXCEPT CANADA)</option>
<option value="AP">ARMED FORCES PACIFIC</option>
</select>
<div for="nf-field-306"></div>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-306" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-307-container" class="nf-field-container zip-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-307-wrap" class="field-wrap zip-wrap" data-field-id="307">
<div class="nf-field-label">
<label for="nf-field-307" id="nf-label-field-307" class=""> Zip <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-307" name="zip" autocomplete="postal-code" aria-invalid="false" aria-describedby="nf-error-307" aria-labelledby="nf-label-field-307"
aria-required="true" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-307" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-316-container" class="nf-field-container listradio-container label-above list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-316-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="316">
<div class="nf-field-label">
<span id="nf-label-field-316" class="nf-label-span "> Best way to contact? </span>
</div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-316">
<li>
<input type="radio" id="nf-field-316-0" name="nf-field-316" class="ninja-forms-field nf-element " value="phone" aria-labelledby="nf-label-class-field-316-0" tabindex="0">
<label for="nf-field-316-0" id="nf-label-class-field-316-0" class="">Phone</label>
</li>
<li>
<input type="radio" id="nf-field-316-1" name="nf-field-316" class="ninja-forms-field nf-element " value="email" aria-labelledby="nf-label-class-field-316-1" tabindex="0">
<label for="nf-field-316-1" id="nf-label-class-field-316-1" class="">Email</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-316" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-302-container" class="nf-field-container phone-container label-above textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-302-wrap" class="field-wrap phone-wrap textbox-wrap" data-field-id="302">
<div class="nf-field-label">
<label for="nf-field-302" id="nf-label-field-302" class=""> Phone <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<input type="tel" value="" class="ninja-forms-field nf-element" id="nf-field-302" name="phone" autocomplete="tel" aria-invalid="false" aria-describedby="nf-error-302" aria-labelledby="nf-label-field-302"
aria-required="true" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-302" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-301-container" class="nf-field-container email-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-301-wrap" class="field-wrap email-wrap" data-field-id="301">
<div class="nf-field-label">
<label for="nf-field-301" id="nf-label-field-301" class=""> Email Address <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<input type="email" value="" class="ninja-forms-field nf-element" id="nf-field-301" name="email" autocomplete="email" aria-invalid="false" aria-describedby="nf-error-301" aria-labelledby="nf-label-field-301"
aria-required="true" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-301" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-310-container" class="nf-field-container html-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-310-wrap" class="field-wrap html-wrap" data-field-id="310">
<div class="nf-field-label">
<label for="nf-field-310" id="nf-label-field-310" class=""> Demographic Information </label>
</div>
<div class="nf-field-element">
<h4>Demographic Information</h4>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-310" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-308-container" class="nf-field-container phone-container label-above textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-308-wrap" class="field-wrap phone-wrap textbox-wrap" data-field-id="308">
<div class="nf-field-label">
<label for="nf-field-308" id="nf-label-field-308" class=""> Age </label>
</div>
<div class="nf-field-element">
<input type="tel" value="" class="ninja-forms-field nf-element" id="nf-field-308" name="phone" autocomplete="tel" aria-invalid="false" aria-describedby="nf-error-308" aria-labelledby="nf-label-field-308">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-308" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-312-container" class="nf-field-container listradio-container label-above list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-312-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="312">
<div class="nf-field-label">
<span id="nf-label-field-312" class="nf-label-span "> Gender <span class="ninja-forms-req-symbol">*</span>
</span>
</div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-312">
<li>
<input type="radio" id="nf-field-312-0" name="nf-field-312" class="ninja-forms-field nf-element " value="female" aria-labelledby="nf-label-class-field-312-0" tabindex="0" required="" aria-required="true">
<label for="nf-field-312-0" id="nf-label-class-field-312-0" class="">Female</label>
</li>
<li>
<input type="radio" id="nf-field-312-1" name="nf-field-312" class="ninja-forms-field nf-element " value="male" aria-labelledby="nf-label-class-field-312-1" tabindex="0" required="" aria-required="true">
<label for="nf-field-312-1" id="nf-label-class-field-312-1" class="">Male</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-312" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-323-container" class="nf-field-container textbox-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-323-wrap" class="field-wrap textbox-wrap" data-field-id="323">
<div class="nf-field-label">
<label for="nf-field-323" id="nf-label-field-323" class=""> Race </label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-323" name="nf-field-323-textbox" autocomplete="on" aria-invalid="false" aria-describedby="nf-error-323" aria-labelledby="nf-label-field-323">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-323" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-324-container" class="nf-field-container textbox-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-324-wrap" class="field-wrap textbox-wrap" data-field-id="324">
<div class="nf-field-label">
<label for="nf-field-324" id="nf-label-field-324" class=""> CCI MD </label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-324" name="nf-field-324-textbox" autocomplete="on" aria-invalid="false" aria-describedby="nf-error-324" aria-labelledby="nf-label-field-324">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-324" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-318-container" class="nf-field-container listradio-container label-above list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-318-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="318">
<div class="nf-field-label">
<span id="nf-label-field-318" class="nf-label-span "> Select Class Date <span class="ninja-forms-req-symbol">*</span>
</span>
</div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-318">
<li>
<input type="radio" id="nf-field-318-0" name="nf-field-318" class="ninja-forms-field nf-element " value="friday-april-19th-at-9-00am-females" aria-labelledby="nf-label-class-field-318-0" tabindex="0" required=""
aria-required="true">
<label for="nf-field-318-0" id="nf-label-class-field-318-0" class="">Friday, April 19th at 9:00am – Females</label>
</li>
<li>
<input type="radio" id="nf-field-318-1" name="nf-field-318" class="ninja-forms-field nf-element " value="friday-april-19th-at-11-00am-males" aria-labelledby="nf-label-class-field-318-1" tabindex="0" required=""
aria-required="true">
<label for="nf-field-318-1" id="nf-label-class-field-318-1" class="">Friday, April 19th at 11:00am - Males</label>
</li>
<li>
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aria-required="true">
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