hra.healthcaresource.com Open in urlscan Pro
52.1.96.59  Public Scan

Form analysis
1 forms found in the DOM

POST /user/respondReference?code=ed6516b6e0ab752499096ea9eaedcd5945240a51

<form action="/user/respondReference?code=ed6516b6e0ab752499096ea9eaedcd5945240a51" method="post">
  <div style="text-align: left; margin-bottom: 10px">
    <label>&nbsp;</label>
    <div class="input ">
      <input type="checkbox" value="1" name="agree" id="agree"> I agree to the <a target="_blank" href="/site/terms/role/Reference">Terms and Conditions</a>
    </div>
  </div>
  <div class="actions centered">
    <input class="btn btn-primary" disabled="disabled" type="submit" name="yt1" value="Continue >>>">
  </div>
</form>

Text Content

WELCOME!

This invitation was created for Martha Fitisemanu.

You have been invited to complete a reference on behalf of Alyssa Kusumoto.
Please accept the terms and conditions below and follow the steps on each page.
Alyssa has agreed to a release of liability to protect any information you
provide.


Click here to view and download the release if desired.

 
I agree to the Terms and Conditions


© 2024 symplr. All rights reserved.
Warning!Close
Your session is about to expire in minutes. Click here to continue your session!
Cancel
Browser Notification!Close
The symplr / RA system has identified that you are using an older browser. You
may experience intermittent issues while using HRA. We recommend that you
upgrade your browser to a newer version.
Continue