registryarthroplasty-paboi.com Open in urlscan Pro
159.223.65.96  Public Scan

Form analysis
1 forms found in the DOM

POST https://registryarthroplasty-paboi.com/login

<form class="" style="height: 100vh" id="login-form" action="https://registryarthroplasty-paboi.com/login" method="post">
  <input type="hidden" name="_token" value="mWmVkLxNFUhLWjhr3BeMlghegHw7muhECwtxMe55" autocomplete="off">
  <div class="row mb-5">
    <div class="p-4">
      <img src="https://registryarthroplasty-paboi.com/storage/settings/GT2mpKMpMq01KrwVNiACD2FzBQCV1vtLinfPKoPp.png" height="70" alt="">
    </div>
  </div>
  <div class="d-flex justify-content-center align-content-center w-100">
    <div class="col-md-10">
      <div class="form-auth bg-white pt-4">
        <h1 class="text-center mb-4">Selamat Datang Kembali!</h1>
        <div class="form mt-4">
          <div class="mb-3">
            <label for="email" class="form-label fw-lighter">Email</label>
            <input type="email" class="form-control" id="email" name="email" placeholder="Masukkan Alamat Email" aria-describedby="emailHelp">
          </div>
          <div class="mb-3">
            <label for="password" class="form-label fw-lighter">Kata Sandi</label>
            <input type="password" class="form-control" id="password" name="password" placeholder="Masukkan Kata Sandi" aria-describedby="passwordHelp">
          </div>
          <div class="mb-3 form-check">
            <input type="checkbox" class="form-check-input" checked="" id="remember">
            <label class="form-check-label" for="remember" name="remember">Biarkan saya tetap masuk</label>
          </div>
          <div class="mb-3">
            <a class="text-end w-100 d-block mt-4" href="https://registryarthroplasty-paboi.com/forgot-password">
                                Lupa password?
                            </a>
          </div>
          <button onclick="submitForm('#login-form')" class="btn btn-primary w-100 fw-normal"> Masuk </button>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

Sistem Infromasi Manajemen Basis Data Pasien


SELAMAT DATANG KEMBALI!

Email
Kata Sandi
Biarkan saya tetap masuk
Lupa password?
Masuk