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patient.lumahealth.io Open in urlscan Pro
2606:4700::6812:35e  Public Scan

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Submitted URL: https://lumalk.com/17awMR7kbpt
Effective URL: https://patient.lumahealth.io/?token=eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI1ZjI1NWYwYmFlYzdhNjAwNGEwYWI0YzEiLCJleHAi...
Submission: On March 11 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

<form style="padding: 20px; position: relative;">
  <div class="jss1231 jss1232 jss1234"><label class="jss1183 jss1184 jss1191 jss1190 jss1195 jss1198 jss1197" data-shrink="true">Patient First Name</label>
    <div class="jss1201 jss1218 jss1222 jss1210 jss1225 jss1203 jss1220 jss1202 jss1219"><input aria-invalid="false" class="jss1211 jss1226 jss1235 jss1214 jss1229" value=""></div>
  </div>
  <div class="jss1231 jss1232 jss1234"><label class="jss1183 jss1190 jss1195 jss1198" data-shrink="false">Patient Last Name</label>
    <div class="jss1201 jss1218 jss1222 jss1210 jss1225 jss1202 jss1219"><input aria-invalid="false" class="jss1211 jss1226 jss1235 jss1214 jss1229" value=""></div>
  </div>
  <div class="jss1231 jss1232 jss1234"><label class="jss1183 jss1190 jss1195 jss1198 jss1197" data-shrink="true">Date of Birth</label>
    <div class="jss1201 jss1218 jss1222 jss1210 jss1225 jss1202 jss1219"><input aria-invalid="false" class="jss1211 jss1226 jss1235 jss1214 jss1229" placeholder="mm/dd/yyyy" value=""></div>
  </div>
  <div style="margin-top: 20px;">
    <div id="g-recaptcha" data-onloadcallbackname="onloadCallback" data-verifycallbackname="verifyCallback">
      <div style="width: 304px; height: 78px;">
        <div><iframe title="reCAPTCHA"
            src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LdTSSoUAAAAALLSIOp_Hc6mBUvKdvIPzVFSu40Y&amp;co=aHR0cHM6Ly9wYXRpZW50Lmx1bWFoZWFsdGguaW86NDQz&amp;hl=en&amp;type=image&amp;v=85AXn53af-oJBEtL2o2WpAjZ&amp;theme=light&amp;size=normal&amp;badge=bottomright&amp;cb=h96ih5ws4b9p"
            width="304" height="78" role="presentation" name="a-qvpsbicoxvhz" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe>
        </div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
          style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
      </div><iframe style="display: none;"></iframe>
    </div><button class="jss1076 jss1077 jss1079 jss1090 jss1092 jss1093 jss1095 jss1099" tabindex="-1" type="submit" disabled="" style="width: 100%; margin: 20px 0px;"><span class="jss1080">Sign in</span></button>
  </div>
</form>

Text Content

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English

If this is a medical emergency, please call 911
Patient First Name

Patient Last Name

Date of Birth


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