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2606:4700::6812:1a2d  Public Scan

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Submitted URL: https://bit.ly/2ErEmT7
Effective URL: https://www.customfeedback.com/link/fae08537df8f436d3dc6913eb23ce49db8a5fac1
Submission: On September 15 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST https://www.customfeedback.com/link/fae08537df8f436d3dc6913eb23ce49db8a5fac1

<form class="KioskView-sections" method="post" action="https://www.customfeedback.com/link/fae08537df8f436d3dc6913eb23ce49db8a5fac1" data-target="web.sections web.form" data-action="web#next change->web#change" data-active="0">
  <div class="KioskView-section is-active" data-target="web.section" data-section="">
    <div class="KioskContent-container">
      <div class="KioskContent-topBar">
        <div class="KioskContent-nav">
          <span class="KioskContent-navText" data-target="web.navText">Step 1 of 4</span>
        </div>
      </div>
      <div class="KioskContent-header">
        <img src="https://d39qpuz0i0okme.cloudfront.net/prod/tmp/210098/new_258258/5f21ee8169ff8/5f21ee8169ffa.png" alt="US Med-Equip, Inc." class="KioskContent-logo">
      </div>
      <div class="KioskContent-content">
        <div class="KioskContent-contentInside">
          <div class="KioskContent-intro" data-placeholder="introductoryText" data-target="web.intro" data-section="rating"
            data-template="&amp;lt;p&amp;gt;How likely is it that you would recommend US Med-Equip, Inc. to a friend or colleague?&amp;lt;/p&amp;gt;">
            <p>How likely is it that you would recommend US Med-Equip, Inc. to a friend or colleague?</p>
          </div>
          <div class="KioskRateButtons-container">
            <div class="KioskRateButtons-items">
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="0" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-0 " tabindex="0">0</span>
              </label>
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="1" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-1 " tabindex="0">1</span>
              </label>
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="2" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-2 " tabindex="0">2</span>
              </label>
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="3" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-3 " tabindex="0">3</span>
              </label>
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="4" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-4 " tabindex="0">4</span>
              </label>
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="5" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-5 " tabindex="0">5</span>
              </label>
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="6" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-6 " tabindex="0">6</span>
              </label>
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="7" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-7 " tabindex="0">7</span>
              </label>
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="8" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-8 " tabindex="0">8</span>
              </label>
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="9" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-9 " tabindex="0">9</span>
              </label>
              <label class="KioskRateButtons-item">
                <input name="rating" type="radio" value="10" data-target="web.rateCheckbox" tabindex="-1">
                <span class="KioskRateButtons-itemButton is-10 " tabindex="0">10</span>
              </label>
            </div>
            <div class="KioskRateButtons-signature">
              <div class="KioskRateButtons-signatureItem"> 0 - Not likely </div>
              <div class="KioskRateButtons-signatureItem"> 10 - Very likely </div>
            </div>
          </div>
          <input type="hidden" data-target="web.templateSettings" data-nps="8.5">
          <div class="KioskContent-fieldError is-active" data-target="web.fieldError" data-name="rating"></div>
        </div>
      </div>
      <div class="KioskContent-action">
        <button data-target="web.nextButton" class="button is-success KioskContent-nextButton" type="submit" tabindex="-1"> Next <i class="KioskContent-arrowIcon is-right is-white"></i>
        </button>
      </div>
    </div>
  </div>
  <div class="KioskView-section  " data-target="web.section" data-section="">
    <div class="KioskContent-container">
      <div class="KioskContent-topBar">
        <div class="KioskContent-nav">
          <button type="button" data-action="web#back" class="button is-secondary" tabindex="-1" style="display: none;"><i class="KioskContent-arrowIcon is-left is-grey"></i></button>
          <span class="KioskContent-navText" data-target="web.navText">Step 2 of 4</span>
        </div>
      </div>
      <div class="KioskContent-header">
        <img src="https://d39qpuz0i0okme.cloudfront.net/prod/tmp/210098/new_258258/5f21ee8169ff8/5f21ee8169ffa.png" alt="US Med-Equip, Inc." class="KioskContent-logo">
      </div>
      <div class="KioskContent-content">
        <div class="KioskContent-contentInside">
          <div class="KioskContent-intro" data-placeholder="introductoryText" data-target="web.intro" data-section="feedback" data-template="&amp;lt;p&amp;gt;Please tell us why you gave us a score of {{Rating}}.&amp;lt;/p&amp;gt;">
            <p>Please tell us why you gave us a score of {{Rating}}.</p>
          </div>
          <div>
            <label class="KioskContent-fieldLabel" style="display: none;">Your feedback</label>
            <textarea name="feedback" rows="5" class="KioskContent-fieldInput KioskContent-feedbackField" data-target="web.field" tabindex="-1" style="display: none;"></textarea>
            <div class="KioskContent-fieldError is-active" data-target="web.fieldError" data-name="feedback"></div>
            <div class="KioskContent-allowUseReviewField" data-placeholder="allowUseReview" style="" data-is-enabled-use-review="" data-target="web.allowUseReviewField"> Allow us to use this as a review on our website and marketing materials: * <br>
              <label class="KioskContent-radioLabel" style="display: none;">
                <input type="radio" name="allowUseReview" value="yes" tabindex="-1" style="display: none;"> Yes </label>
              <label class="KioskContent-radioLabel" style="display: none;">
                <input type="radio" name="allowUseReview" value="no" style="display: none;"> No </label>
            </div>
            <div class="KioskContent-fieldError is-active" data-target="web.fieldError" data-name="allowUseReview"></div>
          </div>
        </div>
      </div>
      <div class="KioskContent-action">
        <button data-target="web.nextButton" class="button is-success KioskContent-nextButton" type="submit" tabindex="-1" style="display: none;"> Next <i class="KioskContent-arrowIcon is-right is-white"></i>
        </button>
      </div>
    </div>
  </div>
  <div class="KioskView-section  " data-target="web.section" data-section="">
    <div class="KioskContent-container">
      <div class="KioskContent-topBar">
        <div class="KioskContent-nav">
          <button type="button" data-action="web#back" class="button is-secondary" tabindex="-1" style="display: none;"><i class="KioskContent-arrowIcon is-left is-grey"></i></button>
          <span class="KioskContent-navText" data-target="web.navText">Step 3 of 4</span>
        </div>
      </div>
      <div class="KioskContent-header">
        <img src="https://d39qpuz0i0okme.cloudfront.net/prod/tmp/210098/new_258258/5f21ee8169ff8/5f21ee8169ffa.png" alt="US Med-Equip, Inc." class="KioskContent-logo">
      </div>
      <div class="KioskContent-content">
        <div class="KioskContent-contentInside">
          <div class="KioskContent-intro" data-placeholder="introductoryText" data-target="web.intro" data-section="contacts" data-template="Please enter your details, so we can validate your feedback as authentic."> Please enter your details, so we
            can validate your feedback as authentic.</div>
          <div class="KioskContent-generalError" data-target="web.generalError"> Apologies but we are experiencing technical issues at the moment. This is likely to be a temporary issue. Please wait 30 seconds and then try saving the form again. If
            the problem persists – please contact customer support and explain them the issue you are experiencing. Sorry for the inconvenience. </div>
          <div class="KioskContent-contactFields">
            <div>
              <label class="KioskContent-fieldLabel" style="display: none;">Your name</label>
              <input name="name" class="KioskContent-fieldInput" type="text" data-target="web.field" tabindex="-1" style="display: none;">
              <div class="KioskContent-fieldError is-active" data-target="web.fieldError" data-name="name"></div>
            </div>
            <div>
              <label class="KioskContent-fieldLabel" style="display: none;">Your email address</label>
              <input name="email" class="KioskContent-fieldInput" type="text" data-target="web.field" tabindex="-1" style="display: none;">
              <div class="KioskContent-fieldError is-active" data-target="web.fieldError" data-name="email"></div>
            </div>
          </div>
          <div style="display: none;" data-placeholder="allowReceiveMarketingEmails">
            <label class="KioskContent-checkLabel" style="display: none;">
              <input type="checkbox" name="allowReceiveMarketingEmails" value="yes" tabindex="-1" style="display: none;"> Allow us to contact you for marketing purposes* </label>
            <div class="KioskContent-fieldError is-active" data-target="web.fieldError" data-name="allowUseReview"></div>
          </div>
        </div>
      </div>
      <div class="KioskContent-action">
        <button data-target="web.nextButton" class="button is-success KioskContent-nextButton" type="submit" tabindex="-1" style="display: none;"> Submit Feedback </button>
      </div>
    </div>
  </div>
  <div class="KioskView-section  " data-target="web.section" data-section="">
    <div class="KioskContent-container">
      <div class="KioskContent-topBar">
        <div class="KioskContent-nav">
          <span class="KioskContent-navText" data-target="web.navText">Step 4 of 4</span>
        </div>
      </div>
      <div class="KioskContent-header">
        <img src="https://d39qpuz0i0okme.cloudfront.net/prod/tmp/210098/new_258258/5f21ee8169ff8/5f21ee8169ffa.png" alt="US Med-Equip, Inc." class="KioskContent-logo">
      </div>
      <div class="KioskContent-content">
        <div class="KioskContent-contentInside">
          <div data-target="web.finalContainer"></div>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

THIS WEBSITE USES COOKIES

We use cookies to personalise content and ads, to provide social media features
and to analyse our traffic. We also share information about your use of our site
with our social media, advertising and analytics partners who may combine it
with other information that you’ve provided to them or that they’ve collected
from your use of their services. You consent to our cookies if you continue to
use our website.
[#OOI_PERSONAL_INFORMATION#]
Use necessary cookies only OK Settings
OK
Use necessary cookies only Allow selection Allow all cookies
Necessary
Preferences
Statistics
Marketing
Settings
Cookie declaration [#IABV2SETTINGS#] About
 Necessary (0) Preferences (0) Statistics (0) Marketing (0) Unclassified (0)
Necessary cookies help make a website usable by enabling basic functions like
page navigation and access to secure areas of the website. The website cannot
function properly without these cookies.

We do not use cookies of this type.

Preference cookies enable a website to remember information that changes the way
the website behaves or looks, like your preferred language or the region that
you are in.

We do not use cookies of this type.

Statistic cookies help website owners to understand how visitors interact with
websites by collecting and reporting information anonymously.

We do not use cookies of this type.

Marketing cookies are used to track visitors across websites. The intention is
to display ads that are relevant and engaging for the individual user and
thereby more valuable for publishers and third party advertisers.

We do not use cookies of this type.

Unclassified cookies are cookies that we are in the process of classifying,
together with the providers of individual cookies.

We do not use cookies of this type.

 [#IABV2_LABEL_PURPOSES#] [#IABV2_LABEL_FEATURES#] [#IABV2_LABEL_PARTNERS#]
[#IABV2_BODY_PURPOSES#]
[#IABV2_BODY_FEATURES#]
[#IABV2_BODY_PARTNERS#]
Cookies are small text files that can be used by websites to make a user's
experience more efficient.

The law states that we can store cookies on your device if they are strictly
necessary for the operation of this site. For all other types of cookies we need
your permission.

This site uses different types of cookies. Some cookies are placed by third
party services that appear on our pages.

You can at any time change or withdraw your consent from the Cookie Declaration
on our website.

Learn more about who we are, how you can contact us and how we process personal
data in our Privacy Policy.
Under construction: The website is currently being scanned for cookies for the
first time.
Step 1 of 4


How likely is it that you would recommend US Med-Equip, Inc. to a friend or
colleague?

0 1 2 3 4 5 6 7 8 9 10
0 - Not likely
10 - Very likely

Next
Step 2 of 4


Please tell us why you gave us a score of {{Rating}}.

Your feedback

Allow us to use this as a review on our website and marketing materials: *
Yes No

Next
Step 3 of 4

Please enter your details, so we can validate your feedback as authentic.
Apologies but we are experiencing technical issues at the moment. This is likely
to be a temporary issue. Please wait 30 seconds and then try saving the form
again. If the problem persists – please contact customer support and explain
them the issue you are experiencing. Sorry for the inconvenience.
Your name

Your email address

Allow us to contact you for marketing purposes*

Submit Feedback
Step 4 of 4