billtopklinik.my.id Open in urlscan Pro
2606:4700:3037::6815:21c4  Public Scan

Form analysis
1 forms found in the DOM

POST https://billtopklinik.my.id/do_auth

<form method="post" action="https://billtopklinik.my.id/do_auth" class="login100-form validate-form">
  <span class="login100-form-title pb-5"> Login </span>
  <div class="panel panel-primary">
    <div class="tab-menu-heading ">
      <div class="tabs-menu1">
        <!-- Tabs -->
        <!-- <ul class="nav panel-tabs">
                                            <li class="mx-0"><a href="#tab5" class="active" data-bs-toggle="tab">Email</a></li>
                                            <li class="mx-0"><a href="#tab6" data-bs-toggle="tab">Mobile</a></li>
                                        </ul> -->
      </div>
    </div>
    <div class="panel-body tabs-menu-body p-0 pt-5">
      <div class="tab-content">
        <div class="tab-pane active" id="tab5">
          <div class="wrap-input100 validate-input input-group" data-bs-validate="">
            <a href="javascript:void(0)" class="input-group-text bg-white text-muted">
                                                    <i class="zmdi zmdi-face text-muted" aria-hidden="true"></i>
                                                </a>
            <input class="input100 border-start-0 form-control ms-0 text-white" type="text" name="username" placeholder="Username">
          </div>
          <div class="wrap-input100 validate-input input-group" id="Password-toggle">
            <a href="javascript:void(0)" class="input-group-text bg-white text-muted">
                                                    <i class="zmdi zmdi-eye text-muted" aria-hidden="true"></i>
                                                </a>
            <input class="input100 border-start-0 form-control ms-0 text-white" type="password" name="password" placeholder="Password">
          </div>
          <!-- <div class="text-end pt-4">
                                                <p class="mb-0"><a href="forgot-password.html" class="text-primary ms-1">Forgot Password?</a></p>
                                            </div> -->
          <div class="container-login100-form-btn">
            <button type="submit" href="index.html" class="login100-form-btn btn-primary"> Login </button>
          </div>
          <!-- <div class="text-center pt-3">
                                                <p class="text-dark mb-0">Not a member?<a href="register.html" class="text-primary ms-1">Sign UP</a></p>
                                            </div>
                                            <label class="login-social-icon"><span>Login with Social</span></label>
                                            <div class="d-flex justify-content-center">
                                                <a href="javascript:void(0)">
                                                    <div class="social-login me-4 text-center">
                                                        <i class="fa fa-google"></i>
                                                    </div>
                                                </a>
                                                <a href="javascript:void(0)">
                                                    <div class="social-login me-4 text-center">
                                                        <i class="fa fa-facebook"></i>
                                                    </div>
                                                </a>
                                                <a href="javascript:void(0)">
                                                    <div class="social-login text-center">
                                                        <i class="fa fa-twitter"></i>
                                                    </div>
                                                </a>
                                            </div> -->
        </div>
        <div class="tab-pane" id="tab6">
          <div id="mobile-num" class="wrap-input100 validate-input input-group mb-4">
            <a href="javascript:void(0)" class="input-group-text bg-white text-muted">
                                                    <span>+91</span>
                                                </a>
            <input class="input100 border-start-0 form-control ms-0">
          </div>
          <div id="login-otp" class="justify-content-around mb-5">
            <input class="form-control text-center w-15" id="txt1" maxlength="1">
            <input class="form-control text-center w-15" id="txt2" maxlength="1">
            <input class="form-control text-center w-15" id="txt3" maxlength="1">
            <input class="form-control text-center w-15" id="txt4" maxlength="1">
          </div>
          <span>Note : Login with registered mobile number to generate OTP.</span>
          <div class="container-login100-form-btn ">
            <a href="javascript:void(0)" class="login100-form-btn btn-primary" id="generate-otp">
                                                    Proceed
                                                </a>
          </div>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

Login
Login
+91

Note : Login with registered mobile number to generate OTP.
Proceed