greenwoodqualityhealthcare.site Open in urlscan Pro
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Form analysis
2 forms found in the DOM

POST /create-contact.php

<form id="contact-form" class="contact__form" method="post" action="/create-contact.php">
  <div class="row">
    <div class="col-sm-6 mb-3">
      <input class="form-control" name="name" id="name" placeholder="Full name" type="text">
    </div>
    <div class="col-sm-6 mb-3">
      <input class="form-control" name="email" id="email" placeholder="Email address" type="email">
    </div>
    <div class="col-sm-6 mb-3">
      <input class="form-control" name="dob" id="dob" placeholder="Your Date of Birth" type="text">
    </div>
    <div class="col-sm-6 mb-3">
      <input class="form-control" id="phone" name="phone_number" placeholder="Phone number" type="text">
    </div>
    <div class="col-sm-6 mb-3">
      <input class="form-control" name="city" id="city" placeholder="Your City" type="text">
    </div>
    <div class="col-sm-6 mb-3">
      <input class="form-control" id="state" name="state" placeholder="Your State" type="text">
    </div>
  </div>
  <div class="form-group mb-5">
    <textarea class="form-control" rows="4" name="street" id="street" placeholder="Your street"></textarea>
  </div>
  <div>
    <input type="checkbox" name="agreement" value="1"> I agree , By submitting my cell phone number to receive automated sms/mms messages with more information or quote from GREENWOOD QUALITY HEALTH CARE. Message frequency may vary. Reply STOP to
    cancel, Reply HELP for contact information. message and date rates may apply <a href="terms-conditions.html">Terms &amp; Conditions</a> | <a href="privacy-policy.html">Privacy Policy</a>
  </div>
  <div class="text-center mt-3">
    <button class="btn btn-primary btn-circled" type="submit">Send</button>
  </div>
</form>

POST /opt-contact.php

<form method="POST" action="/opt-contact.php">
  <div class="modal-body"><input type="text" class="form-control" placeholder="Phone" name="ph" required="">
  </div>
  <div class="modal-footer">
    <button type="button" class="btn btn-secondary closeModalButton">Close</button>
    <button type="submit" class="btn btn-primary">Submit</button>
  </div>
</form>

Text Content

GREENWOOD QUALITY HEALTH CARE

+19493026353

Call Free

GGREENWOOD@BESTBIGTEAM.COM

Email Us

 * Home
 * Terms Conditions
 * Privacy Policy


GIANA GREENWOOD

I'm a Licensed Health Insurance Advisor with years of expertise in the industry,
Regardless of your needs - I have solutions. With access to an array of products
through the top carriers, My focus is on meeting your unique needs. I offer
plans for Individual and Family health coverage.




OUR EXPERTISE


COMPREHENSIVE HEALTH COVERAGE

Get peace of mind with our comprehensive health coverage plans tailored to your
individual and family needs.


EXPERT INSURANCE ADVICE

Trust in our years of expertise as a licensed health insurance advisor, with
access to top carriers and solutions for all your insurance needs.


CUSTOMIZED SOLUTIONS FOR UNIQUE NEEDS

No matter what your specific needs may be, we have the resources and knowledge
to find the best insurance plan for you through our array of products.


REACH OUT TO US

I agree , By submitting my cell phone number to receive automated sms/mms
messages with more information or quote from GREENWOOD QUALITY HEALTH CARE.
Message frequency may vary. Reply STOP to cancel, Reply HELP for contact
information. message and date rates may apply Terms & Conditions | Privacy
Policy
Send

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