File: /home/precisionhealthcareproviders/public_html/contact.php
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<body>
<!--================ Start Header Menu Area =================-->
<header class="header_area">
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<option data-display="English">English</option>
<option value="1">Pending...</option>
</select>
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<div class="col-lg-9 col-sm-6 col-8 header-top-right">
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<a href="mailto:[email protected]"><span class="lnr lnr-envelope"></span> <span class="text"><span class="text">[email protected]</span></span></a>
<a href="tel:+18559997236" class="primary-btn text-uppercase"><span class="lnr lnr-phone-handset"></span> <span class="text"><span class="text">(855) 999-7236</span></span></a>
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<ul class="nav navbar-nav menu_nav ml-auto">
<li class="nav-item"><a class="nav-link" href="about.html">About</a></li>
<li class="nav-item"><a class="nav-link" href="open-enrollment.html">Open Enrollment</a></li>
<li class="nav-item submenu dropdown">
<a href="#" class="nav-link dropdown-toggle" data-toggle="dropdown" role="button" aria-haspopup="true" aria-expanded="false">Departments</a>
<ul class="dropdown-menu">
<li class="nav-item"><a class="nav-link" href="obamacare.html">Obamacare</a></li>
<li class="nav-item"><a class="nav-link" href="short-term.html">Short Term</a></li>
<li class="nav-item"><a class="nav-link" href="association.html">Association</a></li>
<li class="nav-item"><a class="nav-link" href="dental.html">Dental</a></li>
<li class="nav-item"><a class="nav-link" href="vision.html">Vision</a></li>
<li class="nav-item"><a class="nav-link" href="prescription.html">Prescription</a></li>
<li class="nav-item"><a class="nav-link" href="blood-lab.html">Blood & Lab</a></li>
<li class="nav-item"><a class="nav-link" href="medicare.html">Medicare</a></li>
<li class="nav-item"><a class="nav-link" href="medicaid.html">Medicaid</a></li>
<li class="nav-item"><a class="nav-link" href="life.html">Life Insurance</a></li>
</ul>
</li>
<li class="nav-item active"><a class="nav-link" href="contact.html">Contact</a></li>
</ul>
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</div>
<h2>Contact Us</h2>
</div>
</div>
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</section>
<!--================End Home Banner Area =================-->
<!--================Contact Area =================-->
<section class="contact_area" style="padding: 70px 0 0 0;">
<div class="container">
<div class="row">
<div class="col-lg-12">
<div class="contact_info">
<div class="info_item">
<i class="lnr lnr-phone-handset"></i>
<h6><a href="tel:+18559997236">(855) 999-7236</a></h6>
<p>Mon-Fri | 9AM-7PM</p>
</div>
<div class="info_item">
<i class="lnr lnr-envelope"></i>
<h6><a href="#">[email protected]</a></h6>
<p>We Are Always Here To Help!</p>
</div>
</div>
</div>
<div class="col-lg-12">
<form id="valForm" name="valForm" class="valForm" method="get" class="p-4">
<input type="hidden" name="xxTrustedFormCertUrl" id="xxTrustedFormCertUrl_0" value="https://cert.trustedform.com/454a35b802f3e7b63ffabb4efedb7c6ebe67886c">
<input type="hidden" name="DateOfBirth" id="dob">
<input type="hidden" name="CompanyId" id="CompanyId" value="16">
<div class="row">
<h3 class="display-6 mb-3 text-center"> Who are we speaking to?</h3>
<div class="col-md-6">
<div class="form-floating mb-4">
<input id="firstname" type="text" name="firstname" class="firstname form-control alpha required" placeholder="First Name" required>
<label for="firstname d-flex justify-content-center">First Name *</label>
<div class="valid-feedback"> Looks good! </div>
<div class="invalid-feedback"> Please enter your First Name. </div>
</div>
</div>
<!-- /column -->
<div class="col-md-6">
<div class="form-floating mb-4">
<input id="lastname" type="text" name="lastname" class="lastname form-control alpha" placeholder="Last Name" required>
<label for="lastname d-flex justify-content-center">Last Name *</label>
<div class="valid-feedback"> Looks good! </div>
<div class="invalid-feedback"> Please enter your Last Name. </div>
</div>
</div>
<div class="col-md-6">
<div class="form-floating mb-4">
<input type="text" class="form-control phone numer" name="phone" id="phone" placeholder="Phone Number" minlength="10" maxlength="10" maxlength="30" required>
<label for="phone">Phone Number *</label>
<div class="valid-feedback"> Looks good! </div>
<div class="invalid-feedback"> Please enter your Phone Number. </div>
</div>
</div>
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<div class="col-md-6">
<div class="form-floating mb-4">
<input id="email" type="text" name="email" class="email form-control" placeholder="Email Address" required>
<label for="email">Email *</label>
<div class="valid-feedback"> Looks good! </div>
<div class="invalid-feedback"> Please enter your Email Address. </div>
</div>
</div>
<section>
<div class="row">
<h3 class="display-6 mb-3 text-center"> What is your Date of Birth?</h3>
<div class="col-md-4 col-sm-12">
<label>Month</label>
<select id="dobmonth" class="dobmonth form-select" name="month" required></select>
</div>
<div class="col-md-4 col-sm-12">
<label>Day</label>
<select id="dobday" class="dobday form-select" name="day" required></select>
</div>
<div class="col-md-4 col-sm-12">
<label>Year</label>
<select id="dobyear" class="dobyear form-select" name="year" required></select>
</div>
</div>
</section>
<!--Step 5 -->
<section class="wrapper bg-gradient-primary" style="padding-top: 20px;">
<h2 class="display-6 mb-3 text-center"> What is your current address?</h2>
<div class="row formStepper-p-0">
<div class="col-md-12">
<div class="form-floating mb-4">
<input id="address" type="text" name="address" class="address form-control" placeholder="Street Address" required>
<label for="address" class="he-form-field">Street Address *</label>
</div>
</div>
<div class="col-md-4">
<div class="form-floating mb-4">
<input type="text" class="form-control numer zipCode" minlength="5" maxlength="5" name="zip" id="zipCode" placeholder="Zip Code" onkeyup="zipCodeLookup(1);" value="<?php echo $_POST["zipCode"]; ?>">
<label for="zipcode">Zip Code *</label>
</div>
</div>
<!-- /column -->
<div class="col-md-4">
<div class="form-floating mb-4">
<input type="text" class="form-control numer city" name="city" id="city" placeholder="City" value="<?php echo $_POST["city"]; ?>" required>
<label for="city">City *</label>
</div>
</div>
<div class="col-md-4">
<div class="form-floating mb-4">
<input type="text" class="form-control numer state" name="state" id="state" placeholder="State" value="<?php echo $_POST["state"]; ?>" required>
<label for="state">State *</label>
</div>
</div>
<div class="col-md-12">
<p>By Clicking “Connect Now!” above you agree to receive SMS notification regarding
your enrollment application and account registered with, by and from Precision Healthcare Providers.
You will receive “one” text message when you opt in and “one”
text message when you complete an application and sign up with Precision Healthcare Providers
as your agency on record of your application and enrollment process. Future
communications for plan information, billing and updates will be sent “one” time if
there is anything urgent pertaining to your application that requires your immediate
attention. Message and data rates may apply. At any time, you can reply “HELP” for
support or “STOP” to unsubscribe. Before clicking “Connect Now!” above please select
(at least one) forms of communication</p>
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="phonecheckbox" value="option1">
<label class="form-check-label" for="phonecheckbox">Phone</label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="smscheckbox" value="option2">
<label class="form-check-label" for="smscheckbox">SMS</label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="emailcheckbox" value="option3">
<label class="form-check-label" for="emailcheckbox">Email</label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="mailcheckbox" value="option4">
<label class="form-check-label" for="mailcheckbox">Mail</label>
</div>
</div>
<div class="col-md-12">
<p>
By entering a phone number and email address and submitting this form, you represent that you are at least 18 years old and agree to our <a href="privacy.html">Privacy Policy</a> and <a href="privacy.html">Terms of Use</a>. You also authorize precisionhealthcareadvisors.com and/or its
<a data-toggle="modal" href="#partnerModal" style="color: #0031e3; font-style=">marketing partners
</a> to contact you for marketing/telemarketing purposes at the number and address provided above, including your wireless number if provided, using live operators, automated telephone
dialing systems, pre-recorded messages, text messages and/or emails, even if the number you provide is on a state or Federal Do Not Call registry. You are not required to consent as a condition of purchasing goods or services
and may revoke consent at anytime. Precision Healthcare Providers has the option to send communication such as texting via a short code and will not allow third parties to send messages or communications on their behalf.
</p>
<p>
Precision Healthcare Providers is an independent website and is not a federal or state Marketplace website. Precision Healthcare Providers does not provide quotes or sell insurance directly to consumers, is not affiliated with any exchange, and is not a
licensed insurance agent or broker. Accordingly, you should not send us (via mail or email) any sensitive information, including personal health information or applications. Any such communications will not be treated as
confidential and will be discarded, as, in offering this website, we are required to comply with the standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information.
</p>
</div>
<input value="Submit" id="submitButton" sid="datepicker" class="primary-btn text-uppercase" type="submit">
</form>
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z-index: -8 !important;
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width: 600px;
margin: 100px auto;
color: #000;
font-size: 17px;
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margin: 0;
line-height: 1.42857143;
font-size: 24px;
font-weight: 900;
}
</style>
<div class="modal" id="partnerModal" role="dialog" tabindex="-1">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<h5 class="modal-title text-black col-md-6 text-left">
/ Select Partners
</h5><button aria-label="Close" class="close col-6" data-dismiss="modal" type="button"><span aria-hidden="true">×</span></button>
</div>
<div class="modal-body text-black">
<ul style="list-style-type: none; margin: 0; padding: 0;">
<li>Affordable Health Group</li>
<li>Alliance National Health</li>
<li>Alternative Alpha Health, LLC.</li>
<li>America's Health Center, Inc.</li>
<li>America's Health Providers</li>
<li>Cypress Bend Marketing </li>
<li>Fuego Leads, LLC.</li>
<li>Genesis Marketing Group</li>
<li>Get Me Healthcare</li>
<li>Get Me Medicare</li>
<li>H&M Advisors</li>
<li>HIC Marketing Group, LLC.</li>
<li>Health and Medicare Advisors</li>
<li>Medicare Benefits Direct</li>
<li>National Health Agents</li>
<li>National Health Plans, LLC.</li>
<li>SolidQuote, LLC.</li>
<li>New Age Health</li>
<li>Precision Healthcare Providers</li>
<li>Precision Insurance Providers, LLC.</li>
<li>Premier Health Associates</li>
<li>Quotehound, Inc.</li>
<li>Reasonable Health Coverage</li>
<li>Reasonable Insurance Group </li>
<li>Reasonable Insurance Group</li>
<li>Seniors Get Benefits</li>
<li>Tobias and Associates</li>
<li>Trusted Health Associates</li>
<li>Trusted Healthcare Providers, LLC.</li>
<li> Affordable Healthcare Assoicates, LLC. </li>
<li> Allied Health Insurance Agency, LLC. </li>
<li> Direct Insurance Providers, LLC.</li>
<li> New Age Health Solutions</li>
<li>QuoteManage, LLC.</li>
</ul>
</div>
<div class="modal-footer">
<button class="btn btn-secondary" data-dismiss="modal" type="button">Close</button>
</div>
</div>
</div>
</div>
</div>
<!--================Contact Area =================-->
<!--================ Start About Area =================-->
<section class="about_area lite_bg" style="margin-top: 50px;">
<div class="container">
<div class="row align-items-center">
<div class="col-lg-5 col-md-5">
<div class="about_details lite_bg">
<h2>We Are Precision Health</h2>
<p>Precision Healthcare Providers is a nationwide enrollment center for individuals or families searching for affordable health coverage. Our certified, appointed & licensed agents will show you your options; and help you select the
best program that suits all of your needs. We achieve this by reviewing our database and exploring different alternatives. The good news is here we are able to help you and your family save money and get you the best coverage
available in the private market. You can get quotes the fast and easy way with Precision Healthcare Providers!</p>
<p>Our services are available throughout the country. We also offer health insurance options from major companies along with A+ rated carriers. Once you have chosen a program, our certified, appointed & licensed agents will guide
you through the application process, expedite your enrollment, review the main details of your options including the associations, and you’ll be informed regarding your status.</p>
<p>Precision Healthcare Providers is currently one of the leading health insurance agencies. We offer a wide variety of health and life insurance options. The selections that we offer are customizable and tailored to the client’s
specific needs. We offer multiple products and alternatives that can be bundled with any of the individual or family packages selected.</p>
</div>
</div>
<div class="col-lg-4 offset-lg-3 col-md-6 offset-md-1">
<div class="about_right overlay">
<div class="about_inner text-center">
<h4><i class="fas fa-user-clock fa-2x"></i><br><br>Broker Hours</h4>
<p>Monday - Friday<br><span style="font-style: italic;">9AM - 7PM <span style="font-size: 10pt;">EST</span></span>
</p>
<p>Saturday & Sunday<br><span style="font-style: italic;">Closed</span></p>
</div>
</div>
</div>
</div>
<div class="about_bg overlay"></div>
</div>
</section>
<!--================ End About Area =================-->
<!--================ Start Department Area =================-->
<section class="department_area section_gap">
<div class="container">
<div class="row justify-content-center">
<div class="col-lg-7">
<div class="main_title">
<h2>Popular Departments</h2>
<p>Offering all of your options, means offering all of your options, period.</p>
</div>
</div>
</div>
<div class="row">
<!-- single department -->
<div class="col-lg-2 text-center col-sm-6">
<a href="obamacare.html">
<div class="single_department">
<div class="dpmt-thumb">
<img src="img/department/d-icon1.png" alt="">
</div>
<h4>Obamacare</h4>
</div>
</a>
</div>
<!-- single department -->
<div class="col-lg-2 text-center col-sm-6">
<a href="short-term.html">
<div class="single_department">
<div class="dpmt-thumb">
<img src="img/department/d-icon2.png" alt="">
</div>
<h4>Short Term</h4>
</div>
</a>
</div>
<!-- single department -->
<div class="col-lg-2 text-center col-sm-6">
<a href="association.html">
<div class="single_department">
<div class="dpmt-thumb">
<img src="img/department/d-icon7.png" alt="">
</div>
<h4>Association</h4>
</div>
</a>
</div>
<!-- single department -->
<div class="col-lg-2 text-center col-sm-6">
<a href="dental.html">
<div class="single_department">
<div class="dpmt-thumb">
<img src="img/department/d-icon3.png" alt="">
</div>
<h4>Dental</h4>
</div>
</a>
</div>
<!-- single department -->
<div class="col-lg-2 text-center col-sm-6">
<a href="vision.html">
<div class="single_department">
<div class="dpmt-thumb">
<img src="img/department/d-icon4.png" alt="">
</div>
<h4>Vision</h4>
</div>
</a>
</div>
<!-- single department -->
<div class="col-lg-2 text-center col-sm-6">
<a href="prescription.html">
<div class="single_department">
<div class="dpmt-thumb">
<img src="img/department/d-icon6.png" alt="">
</div>
<h4>Prescription</h4>
</div>
</a>
</div>
</div>
</div>
</section>
<!--================ End Department Area =================-->
<!--================ Start Counter Area =================-->
<section class="section_gap counter_area overlay">
<div class="container">
<div class="row">
<!--single-counter-->
<div class="col-lg-3 col-sm-6">
<div class="single_counter">
<p>Over</p>
<h1><span class="counter_number">15</span></h1>
<p>Years of<br>Experience</p>
</div>
</div>
<!--single-counter-->
<div class="col-lg-3 col-sm-6">
<div class="single_counter">
<p>With Over</p>
<h1><span class="counter_number">25</span>K</h1>
<p>Active <br> Clients</p>
</div>
</div>
<!--single-counter-->
<div class="col-lg-3 col-sm-6">
<div class="single_counter">
<p>More Than</p>
<h1><span class="counter_number">100</span></h1>
<p>Products <br> Available</p>
</div>
</div>
<!--single-counter-->
<div class="col-lg-3 col-sm-6">
<div class="single_counter">
<p>Active in</p>
<h1><span class="counter_number">46</span></h1>
<p>States <br> Nationwide</p>
</div>
</div>
</div>
</div>
</section>
<!--================ Start Counter Area =================-->
<!--================ Start footer Area =================-->
<footer class="footer-area section-gap">
<div class="footer_top section_gap">
<div class="container">
<div class="row">
<div class="col-lg-6 col-md-6 col-sm-12">
<div class="single-footer-widget text-center">
<h4 class="text-white">Precision Health</h4>
<p style="font-size: 1.25em;">
As a nationwide enrollment center we assist individuals and families searching for their best health coverage at the best price. Talk with an agent today!
</p>
</div>
</div>
<div class="col-lg-6 col-md-6 col-sm-12">
<div class="single-footer-widget text-center">
<h4 class="text-white">Contact Us</h4>
<p class="number"><a href="tel:+18559997236">(855) 999-7236</a></p>
</div>
</div>
</div>
</div>
</div>
<div class="footer-bottom">
<div class="container">
<div class="text-center align-items-center">
<p class="footer-text">Copyright ©<script>document.write(new Date().getFullYear());</script> - All Rights Reserved | <a href="https://www.precisionhealthcareproviders.com" target="_blank">Precision Healthcare Providers</a></p>
</div>
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</div>
</footer>
<!--================ End footer Area =================-->
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<script>
/*-----------------------------------------------------------------------*/
/*--------------------------- Date of Birth ----------------------------*/
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$(document).ready(function() {
$.getJSON('https://api.ipify.org?format=jsonp&callback=?', function(data) {
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minimumAge: 18,
/* Optional */
maximumAge: 100 /* Optional */
});
});
</script>
<script>
window.dataLayer = window.dataLayer || [];
$.dataLayer.push({
'event':'ec_formsubmit',
'enhanced_conversion_data': {
first_name: $('#firstname').val(),
last_name: $('#lastname').val(),
phone_number: $('#phone').val(),
email_address: $('#email').val(),
street: $('#street').val(),
city: $('#city').val(),
postal_code: $('#zip').val(),
dobday: $('#dobday').val(),
dobmonth: $('#dobmonth').val(),
dobyear: $('#dobyear').val(),
date_of_birth: $('#dob').val(),
plan_condition: $('.planConditions').val(),
plan_option: $('.planOption').val(),
}
})
</script>
<script>
/*-----------------------------------------------------------------------*/
/*---------------------------- Validation --------------------------*/
/*-----------------------------------------------------------------------*/
var form = $("#valForm");
form.validate({
errorPlacement: function errorPlacement(error, element) {
element.before(error);
},
rules: {
firstname: {
required: true,
maxlength: "30"
},
lastname: {
required: true,
maxlength: "30"
},
dobmonth: {
required: true,
date: true
},
dobday: {
required: true
},
dobyear: {
required: true
},
phone: {
required: true,
minlength: 10,
maxlength: 10,
phoneUS: true
},
email: {
required: true
},
address: {
required: true
},
zipCode: {
required: true,
minlength: 5,
maxlength: 5
},
city: {
required: true
},
state: {
required: true
}
},
messages: {
firstname: {
required: "Please enter a valid First Name"
},
lastname: {
required: "Please enter a valid Last Name"
},
phone: {
required: "Please enter a valid phone number"
},
email: {
required: "Please enter a valid Email Address"
},
address: {
required: "Please enter a valid Street Address",
},
zipCode: {
required: "Please enter a valid Zip Code",
},
city: {
required: "Please enter a valid City",
},
state: {
required: "Please enter a valid State",
}
},
});
</script>
<script>
/*-----------------------------------------------------------------------*/
/*---------------------------- DATA POST --------------------------*/
/*-----------------------------------------------------------------------*/
$("#formStepper").steps({
headerTag: "h4",
bodyTag: "section",
transitionEffect: "slideLeft",
autoFocus: true,
onStepChanging: function(event, currentIndex, newIndex) {
var zipCode = $('#zipCode').val();
if (zipCode.length == 5) {
$.ajax({
type: 'GET',
url: 'https://ziplookup.visualyzers.com/Ziplookup?zipcode=' + zipCode,
success: function(results) {
if (!results) {
$('#errorZip').show();
$('#submitButton').prop("disabled", true);
} else {
$('#city').val(results.city);
$('#state').val(results.state);
$('#errorZip').hide();
$('#submitButton').prop("disabled", false);
}
}
})
}
return form.valid();
},
//Plugin Posting ajax
onFinished: function(event, currentIndex) {
var formValid = form.valid();
if(!formValid)
{
return false;
}
var phoneNumber = $('#phone').val();
$.ajax({
type: 'post',
dataType: 'jsonp',
url: 'https://ushaleads.healthinsuranceguide.org/api/LeadAPI',
data: $('form').serialize(),
success: function() {
console.log('success');
console.log('./form-success.php?phoneNumber=' + phoneNumber);
window.location.href = './form-success.php?phoneNumber=' + phoneNumber;
},
error: function() {
console.log('Error');
console.log('./form-success.php?phoneNumber=' + phoneNumber);
window.location.href = './form-success.php?phoneNumber=' + phoneNumber;
}
});
}
})
</script>
<script>
/*-----------------------------------------------------------------------*/
/*---------------------------- FORM FUNCTION --------------------------*/
/*-----------------------------------------------------------------------*/
$(document).ready(function() {
if ($("#formStepper").steps("getCurrentIndex") == 0 || $("#formStepper").steps("getCurrentIndex") ==
1) {
$('.actions').hide()
} else {
$('.actions').show()
}
$('.planOptions').click(function() {
if ($("#formStepper").steps("getCurrentIndex") == 0) {
$('.actions').hide()
$("#formStepper").steps("setStep", 1);
}
})
$('.planConditions').click(function() {
if ($("#formStepper").steps("getCurrentIndex") == 1) {
$('.actions').show()
$("#formStepper").steps("setStep", 2);
}
})
$('#dobmonth').change(function() {
console.log('month');
$('#dob').val($('#dobmonth').val() + '-' + $('#dobday').val() + '-' + $('#dobyear').val());
});
$('#dobday').change(function() {
console.log('day');
$('#dob').val($('#dobmonth').val() + '-' + $('#dobday').val() + '-' + $('#dobyear').val());
});
$('#dobyear').change(function() {
console.log('year');
$('#dob').val($('#dobmonth').val() + '-' + $('#dobday').val() + '-' + $('#dobyear').val());
});
})
</script>
<script>
/* ZIPCODE */
$('#zipCode').on("input", function() {
var zipCode = $('#zipCode').val();
if (zipCode.length == 5) {
$.ajax({
type: 'GET',
url: 'https://ziplookup.visualyzers.com/Ziplookup?zipcode=' + zipCode,
success: function(results) {
if (!results) {
$('#errorZip').show();
$('#submitButton').prop("disabled", true);
} else {
$('#city').val(results.city);
$('#state').val(results.state);
$('#errorZip').hide();
$('#submitButton').prop("disabled", false);
}
}
})
}
});
</script>
<script>
$(document)
.on('keydown', '.alpha', function(e) {
var a = e.key;
if (a.length == 1) return /[a-z]|\$|#|\*/i.test(a);
return true;
})
$(document)
.on('keydown', '.numer', function(e) {
var a = e.key;
if (a.length == 1) return /[0-9]|\$|#|\*/i.test(a);
return true;
})
// now the digit 0 on your mask pattern will be interpreted
// as valid characters like 0,1,2,3,4,5,6,7,8,9 and *
</script>
<!--Vendor-JS-->
<script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.bundle.min.js" integrity="sha384-MrcW6ZMFYlzcLA8Nl+NtUVF0sA7MsXsP1UyJoMp4YLEuNSfAP+JcXn/tWtIaxVXM" crossorigin="anonymous"></script>
<!--Plugin-JS-->
<!--gmaps Js-->
<script src="https://maps.googleapis.com/maps/api/js?key=AIzaSyCjCGmQ0Uq4exrzdcL6rvxywDDOvfAu6eE"></script>
<script src="https://kit.fontawesome.com/69fd8ad995.js" crossorigin="anonymous"></script>
<script src="js/theme.js"></script>
</body>
</html>