www.patientpoint.com
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Submitted URL: https://go.patientpoint.com/e/127251/support/4nzgq4/740916252?h=9k4G0pgn9BkMAcnpUsgNRjTaHAvrpt47ukV8nHPW6kE
Effective URL: https://www.patientpoint.com/support
Submission: On December 28 via manual from US — Scanned from DE
Effective URL: https://www.patientpoint.com/support
Submission: On December 28 via manual from US — Scanned from DE
Form analysis
2 forms found in the DOMGET /search
<form action="/search" method="get" id="views-exposed-form-search-page-1" accept-charset="UTF-8" data-once="form-updated" data-drupal-form-fields="edit-site-search">
<div class="form--inline PPSearch clearfix">
<div class="close-mobile-search"></div>
<div class="js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-site-search form-item-site-search search-wrap">
<label for="edit-site-search" class="search-label">Search</label>
<input placeholder="Search" class="site-search-input form-text" data-drupal-selector="edit-site-search" type="text" id="edit-site-search" name="site-search" value="" size="30" maxlength="128">
</div>
<div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-wrapper" id="edit-actions--3"><input class="site-search-button button js-form-submit form-submit" data-drupal-selector="edit-submit-search" type="submit"
id="edit-submit-search" value="Search">
</div>
</div>
</form>
POST /support
<form
class="webform-submission-form webform-submission-add-form webform-submission-customer-support-no-account-id-form webform-submission-customer-support-no-account-id-add-form webform-submission-customer-support-no-account-id-block_content-5421-form webform-submission-customer-support-no-account-id-block_content-5421-add-form webform-submission-customer-support-no-account-id-block-content-5421-add-form js-webform-details-toggle webform-details-toggle"
data-drupal-selector="webform-submission-customer-support-no-account-id-block-content-5421-add-form" action="/support" method="post" id="webform-submission-customer-support-no-account-id-block-content-5421-add-form" accept-charset="UTF-8"
data-once="form-updated" data-drupal-form-fields="edit-first-name,edit-last-name,edit-job-title,edit-practice,edit-state,edit-email,edit-phone,edit-whats-going-on,edit-actions-submit,edit-url">
<div class="textGrp clearfix js-form-wrapper form-wrapper" data-drupal-selector="edit-text-grp" id="edit-text-grp">
<div class="form-group form-group-half js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-first-name form-item-first-name">
<label for="edit-first-name" class="js-form-required form-required">First Name</label>
<input class="textBox form-text required" data-webform-required-error=""First Name" is a required field." data-drupal-selector="edit-first-name" type="text" id="edit-first-name" name="first_name" value="" size="60" maxlength="255"
required="required" aria-required="true">
</div>
<div class="form-group form-group-half last js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-last-name form-item-last-name">
<label for="edit-last-name" class="js-form-required form-required">Last Name</label>
<input class="textBox form-text required" data-webform-required-error=""Last Name" is a required field." data-drupal-selector="edit-last-name" type="text" id="edit-last-name" name="last_name" value="" size="60" maxlength="255"
required="required" aria-required="true">
</div>
<div class="form-group form-group-half js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-job-title form-item-job-title">
<label for="edit-job-title">Job Title</label>
<input class="textBox form-text" data-webform-required-error=""Company" is a required field." data-drupal-selector="edit-job-title" type="text" id="edit-job-title" name="job_title" value="" size="60" maxlength="255">
</div>
<div class="form-group form-group-half last js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-practice form-item-practice">
<label for="edit-practice" class="js-form-required form-required">Practice</label>
<input class="textBox form-text required" data-webform-required-error=""Company" is a required field." data-drupal-selector="edit-practice" type="text" id="edit-practice" name="practice" value="" size="60" maxlength="255"
required="required" aria-required="true">
</div>
<div class="form-group form-group-half js-form-item form-item js-form-type-select form-type-select js-form-item-state form-item-state">
<label for="edit-state" class="js-form-required form-required">State</label>
<select class="textBox form-select required" style="display: block; width: 100%; height: 40px; border: 1px solid #5e6a71;" data-drupal-selector="edit-state" id="edit-state" name="state" required="required" aria-required="true">
<option value="" selected="selected">- Select -</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select>
</div>
<div class="form-group form-group-half js-form-item form-item js-form-type-email form-type-email js-form-item-email form-item-email">
<label for="edit-email" class="js-form-required form-required">Email</label>
<input class="textBox form-email required" data-webform-required-error=""Email" is a required field." data-drupal-selector="edit-email" type="email" id="edit-email" name="email" value="" size="60" maxlength="254" required="required"
aria-required="true">
</div>
<div class="form-group form-group-half last js-form-item form-item js-form-type-tel form-type-tel js-form-item-phone form-item-phone">
<label for="edit-phone" class="js-form-required form-required">Phone</label>
<input class="textBox form-tel required" data-webform-required-error=""Phone" is a required field." data-drupal-selector="edit-phone" type="tel" id="edit-phone" name="phone" value="" size="30" maxlength="128" required="required"
aria-required="true">
</div>
</div>
<div class="js-form-item form-item js-form-type-textarea form-type-textarea js-form-item-whats-going-on form-item-whats-going-on">
<label for="edit-whats-going-on" class="js-form-required form-required">Whats going on?</label>
<div class="form-textarea-wrapper">
<textarea data-drupal-selector="edit-whats-going-on" id="edit-whats-going-on" name="whats_going_on" rows="5" cols="60" class="form-textarea required resize-vertical" required="required" aria-required="true"></textarea>
</div>
</div>
<input data-drupal-selector="edit-posturl" type="hidden" name="posturl" value="https://go.patientpoint.com/l/127251/2022-07-29/4k7mrk">
<div data-drupal-selector="edit-actions" class="form-actions webform-actions js-form-wrapper form-wrapper" id="edit-actions"><input class="webform-button--submit CTAButton button button--primary js-form-submit form-submit"
data-drupal-selector="edit-actions-submit" type="submit" id="edit-actions-submit" name="op" value="Submit">
</div>
<input autocomplete="off" data-drupal-selector="form-6zt15e9picepji4kfdcv0r7o023ochh5fegurineg4e" type="hidden" name="form_build_id" value="form-6zT15e9PICEPjI4kfDcv0r7O023OchH5fegURineg4E">
<input data-drupal-selector="edit-webform-submission-customer-support-no-account-id-block-content-5421-add-form" type="hidden" name="form_id" value="webform_submission_customer_support_no_account_id_block_content_5421_add_form">
<div class="url-textfield js-form-wrapper form-wrapper" style="display: none !important;">
<div class="js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-url form-item-url">
<label for="edit-url">Leave this field blank</label>
<input autocomplete="off" data-drupal-selector="edit-url" type="text" id="edit-url" name="url" value="" size="20" maxlength="128" class="form-text">
</div>
</div>
</form>
Text Content
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