care.cvs.com
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104.81.137.106
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URL:
https://care.cvs.com/results/?xid=ERz0Dlge&programName=EPIC_RESULTS
Submission: On May 27 via manual from US — Scanned from US
Submission: On May 27 via manual from US — Scanned from US
Form analysis 1 forms found in the DOM
<form _ngcontent-equ-c37="" novalidate="" class="form ng-untouched ng-pristine ng-invalid"><label _ngcontent-equ-c37="" id="dateOfBirthLabel" class="font-weight-bold span-label mb-0 pt-4"> James’s date of birth </label><!----><!---->
<div _ngcontent-equ-c37="" class="same-line">
<div _ngcontent-equ-c37="" id="dob-line" class="mt-1 pr-2"></div>
<div _ngcontent-equ-c37="" class="same-line width-adjustment">
<div _ngcontent-equ-c37="" class="col-6 col-xs-6 col-sm-6 col-md-6 col-lg-6 col-xl-6 pl-0 pr-1"><label _ngcontent-equ-c37="" id="monthLabel" class="font-weight-bold span-label"> Month </label><select _ngcontent-equ-c37=""
autocomplete="bday-month" aria-labelledby="dateOfBirthLabel monthLabel" aria-describedby="monthError dobError recheckMonthError" name="month" formcontrolname="month" id="month"
class="form-control form control-lg ng-untouched ng-pristine ng-invalid">
<option _ngcontent-equ-c37="" disabled="" selected="" value="" hidden=""></option>
<option _ngcontent-equ-c37="" value="1: 01">January</option>
<option _ngcontent-equ-c37="" value="2: 02">February</option>
<option _ngcontent-equ-c37="" value="3: 03">March</option>
<option _ngcontent-equ-c37="" value="4: 04">April</option>
<option _ngcontent-equ-c37="" value="5: 05">May</option>
<option _ngcontent-equ-c37="" value="6: 06">June</option>
<option _ngcontent-equ-c37="" value="7: 07">July</option>
<option _ngcontent-equ-c37="" value="8: 08">August</option>
<option _ngcontent-equ-c37="" value="9: 09">September</option>
<option _ngcontent-equ-c37="" value="10: 10">October</option>
<option _ngcontent-equ-c37="" value="11: 11">November</option>
<option _ngcontent-equ-c37="" value="12: 12">December</option><!---->
</select><!----></div>
<div _ngcontent-equ-c37="" class="col-3 col-xs-3 col-sm-3 col-md-3 col-lg-3 col-xl-3 pl-1 pr-1"><label _ngcontent-equ-c37="" id="dayLabel" class="font-weight-bold span-label"> Day </label><select _ngcontent-equ-c37="" autocomplete="bday-day"
aria-labelledby="dateOfBirthLabel dayLabel" aria-describedby="dayError recheckDayError" name="day" formcontrolname="day" id="day" class="form-control form control-lg ng-untouched ng-pristine ng-invalid">
<option _ngcontent-equ-c37="" disabled="" selected="" value="" hidden=""></option>
<option _ngcontent-equ-c37="" value="1: 01">1</option>
<option _ngcontent-equ-c37="" value="2: 02">2</option>
<option _ngcontent-equ-c37="" value="3: 03">3</option>
<option _ngcontent-equ-c37="" value="4: 04">4</option>
<option _ngcontent-equ-c37="" value="5: 05">5</option>
<option _ngcontent-equ-c37="" value="6: 06">6</option>
<option _ngcontent-equ-c37="" value="7: 07">7</option>
<option _ngcontent-equ-c37="" value="8: 08">8</option>
<option _ngcontent-equ-c37="" value="9: 09">9</option>
<option _ngcontent-equ-c37="" value="10: 10">10</option>
<option _ngcontent-equ-c37="" value="11: 11">11</option>
<option _ngcontent-equ-c37="" value="12: 12">12</option>
<option _ngcontent-equ-c37="" value="13: 13">13</option>
<option _ngcontent-equ-c37="" value="14: 14">14</option>
<option _ngcontent-equ-c37="" value="15: 15">15</option>
<option _ngcontent-equ-c37="" value="16: 16">16</option>
<option _ngcontent-equ-c37="" value="17: 17">17</option>
<option _ngcontent-equ-c37="" value="18: 18">18</option>
<option _ngcontent-equ-c37="" value="19: 19">19</option>
<option _ngcontent-equ-c37="" value="20: 20">20</option>
<option _ngcontent-equ-c37="" value="21: 21">21</option>
<option _ngcontent-equ-c37="" value="22: 22">22</option>
<option _ngcontent-equ-c37="" value="23: 23">23</option>
<option _ngcontent-equ-c37="" value="24: 24">24</option>
<option _ngcontent-equ-c37="" value="25: 25">25</option>
<option _ngcontent-equ-c37="" value="26: 26">26</option>
<option _ngcontent-equ-c37="" value="27: 27">27</option>
<option _ngcontent-equ-c37="" value="28: 28">28</option>
<option _ngcontent-equ-c37="" value="29: 29">29</option>
<option _ngcontent-equ-c37="" value="30: 30">30</option>
<option _ngcontent-equ-c37="" value="31: 31">31</option><!---->
</select><!----></div>
<div _ngcontent-equ-c37="" class="col-3 col-xs-3 col-sm-3 col-md-3 col-lg-3 col-xl-3 pr-0 pl-1"><label _ngcontent-equ-c37="" id="yearLabel" class="font-weight-bold span-label"> Year <small _ngcontent-equ-c37="">(YYYY)</small></label><input
_ngcontent-equ-c37="" autocomplete="bday-year" aria-labelledby="dateOfBirthLabel yearLabel" aria-describedby="yearError recheckYearError" minlength="4" maxlength="4" type="tel" name="year" formcontrolname="year" id="year"
class="form-control form control-lg ng-untouched ng-pristine ng-invalid" min="1872" max="2022"><!----></div>
</div>
</div><!----><label _ngcontent-equ-c37="" for="PN" id="phoneNumber" class="phone-number"> Mobile number </label><input _ngcontent-equ-c37="" autocomplete="tel-national" formcontrolname="PN" id="PN" type="tel" name="PN" appphonemask=""
aria-labelledby="phoneNumber" maxlength="14" aria-describedby="phonehint validationError invalidError" class="form-control form control-lg ng-untouched ng-pristine ng-invalid"><small _ngcontent-equ-c37="" id="phonehint" class="form-text">10-digit
number used for scheduling</small><!----><small _ngcontent-equ-c37="" class="form-text form-text-acknowledgement">By verifying this information you legally confirm that you are, or are acting as caregiver for, this person. </small><button
_ngcontent-equ-c37="" mat-button="" type="submit" aria-label="Verify identity" class="mat-focus-indicator mat-raised-button mat-button-base mat-primary verify-identity mat-button"><span class="mat-button-wrapper"> Verify identity </span><span
matripple="" class="mat-ripple mat-button-ripple"></span><span class="mat-button-focus-overlay"></span></button>
</form>Text Content
App Release Version: 2022.03.10 LET’S VERIFY JAMES’S IDENTITY. One quick step to protect your privacy. All fields are required. James’s date of birth Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day 12345678910111213141516171819202122232425262728293031 Year (YYYY) Mobile number 10-digit number used for schedulingBy verifying this information you legally confirm that you are, or are acting as caregiver for, this person. Verify identity NEED HELP? If you’re unable to verify your identity, please contact us. Top * CVS Pharmacy® * CVS Caremark® * MinuteClinic® * Aetna® * Send Feedback * MinuteClinic Virtual Care Legal Forms * © Copyright 2020 to 2022 CVS Pharmacy, Inc. FeedbackLaunches comment card in new window