gwgpz-nqaaa-aaaad-qbeta-cai.raw.icp0.io
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https://gwgpz-nqaaa-aaaad-qbeta-cai.raw.icp0.io/
Submission: On January 03 via api from US — Scanned from FR
Submission: On January 03 via api from US — Scanned from FR
Form analysis
1 forms found in the DOMPOST #
<form action="#" method="post" id="scheduleForm">
<div id="whatsappFormResponse"></div>
<div class="appointment-form-item">
<label for="pdate" class="common-body-text">Enter Your Name</label>
<input id="pdate" class="common-input input-style-one" name="name" value="" required="">
</div>
<div class="appointment-form-item" id="session_time_input">
<label for="sessionTime" class="common-body-text">Pick a Time</label>
<select id="sessionTime" class="common-input input-style-one select-dropdown" name="time" required="">
<option value="">Please select a date for your appointment</option>
</select>
</div>
<div class="appointment-form-item" id="appointment_medium_input">
<label for="appointment_medium" class="common-body-text">How would you like to have your consultation?</label>
<input id="reason" type="text" class="common-input input-style-one" name="reason">
</div>
<div class="appointment-form-item" id="for_me_input">
<label for="for_me" class="common-body-text">Are you scheduling this appointment for yourself?</label>
<select id="for_me" class="common-input input-style-one select-dropdown" name="for_me" required="">
<option value="1">Yes, its for me</option>
<option value="0">No, its for someone else</option>
</select>
</div>
<div class="appointment-form-item" id="reason_input">
<label for="reason" class="common-body-text">Reason for Booking the Appointment</label>
<input id="reason" type="text" class="common-input input-style-one" name="reason">
</div>
<div class="appointment-form-item" id="usernameWrapper">
<label for="id" class="common-body-text">SWH ID/HMO ID (Optional)</label>
<input type="text" id="id" name="username" class="common-input input-style-one" placeholder="Please enter only one of the above identifiers">
</div>
<!--<div class="appointment-form-item">-->
<!--<label for="sessionEmail" class="common-body-text">Email Address</label>-->
<!--<input id="sessionEmail" type="email" class="common-input input-style-one">-->
<!--</div>-->
<button type="submit" name="submit" class="btn primary-btn" id="scheduleFormBtn" disabled="disabled">Submit</button>
</form>
Text Content
* About * Store * 017001584 * 8AM - 8PM daily * About us * Store * 017001584 * 8AM - 8PM daily TALK TO A DOCTOR FROM HOME HAVE AN ONLINE CONSULTATION AND GET YOUR PRESCRIPTIONS DELIVERED TO YOU TODAY! Schedule Appointment Like us! Chat with us! Recommend us! Follow us! URGENT HEALTH CARE NEAR YOU Prompt medical attention for illness or injury in children and adults. MANAGING LONG TERM ILLNESS Management of chronic conditions like diabetes and high blood pressure to ensure longevity. HEALTH CHECK UPS Routine health checks are the key to maintaining the good health and well-being of everyone in the family. Newborn Immunizations/Vaccination All great things start from small beginnings! Health checks provide the recommended growth, developmental assessments and immunizations to give your child the best start to a life of optimal physical, mental and social health. Children 2 – 18 Check ups that help them grow up to achieve their full potential as adults. Our children’s check includes a head to toe assessment to ensure they grow up to be brilliant, strong and healthy. Women Older than 18 A focus on everything necessary to maintain good health. Includes recommended age-appropriate screening for breast and cervical cancer. Men Older Than 18 A focus on everything necessary to maintain good health. Includes recommended age-appropriate screening for prostate cancer. Employment Check - Basic Basic employment check to ensure the health and fitness of your staff to complete required tasks. Employment Check - Comprehensive Basic employment check to ensure the health and fitness of your staff to complete required tasks. Comprehensive screening includes additional screening for infections that may be transmitted in the workplace. WHAT OTHERS ARE SAYING ABOUT US Great Service – @A_Feranmi I enjoyed the services and it was lovely from start to finish. – Jennifer Onochie Read more great things about us... Click here Oops...An error seems to have occurred. BOOK AN APPOINTMENT Enter Your Name Pick a Time Please select a date for your appointment How would you like to have your consultation? Are you scheduling this appointment for yourself? Yes, its for me No, its for someone else Reason for Booking the Appointment SWH ID/HMO ID (Optional) Submit © 2021 Sam-Williez Heritage. All Rights Reserved.