<?xml version="1.0" encoding="UTF-8"?> <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <head> <meta content="text/html; charset=UTF-8" http-equiv="content-type" /> <meta http-equiv="cache-control" content="max-age=0" /> <meta http-equiv="cache-control" content="no-cache" /> <meta http-equiv="expires" content="0" /> <meta http-equiv="expires" content="Tue, 01 Jan 1980 1:00:00 GMT" /> <meta http-equiv="pragma" content="no-cache" /> <meta name="viewport" content="width=device-width, initial-scale=1"> <title>Patient Portal Login Form</title> <style type="text/css"> html,body { font-family: "Open Sans Condensed", sans-serif; margin: 0; padding: 0; position: relative; } #container { max-width: 100%; padding-right: 15px; padding-left: 15px; margin-right: auto; margin-left: auto; } #content-box { padding: 20px; position: relative; z-index: 1; min-height: 500px; } #login-info { padding: 20px; max-width: 400px; min-width: 250px; margin: 100px auto; } #login-container { max-width: 100%; padding: 10px; background: rgba(161, 161, 161, 0.3); border-top-color: rgba(255,255,255,.4); border-left-color: rgba(255,255,255,.4); border-bottom-color: rgba(60,60,60,.4); border-right-color: rgba(60,60,60,.4); border: 1px solid; } #login-window { padding: 5px 20px 20px; } #register-username, #forgot-username { padding: 5px 20px 20px; } h1{ display: block; background: #34383c; color: #fff; text-align: center; margin: -10px -11px 20px; padding: 15px; text-transform: uppercase; font-size: 1em; } fieldset { min-width: 0; padding: 0; margin: 0; border: 0; } .input-group { width: 100%; margin-bottom: 20px; } #bg { position: fixed; left: 0; top: 0; width: 100%; height: 100%; background-size: cover; -webkit-filter: blur(5px); } form input, form button { width: calc(100% - 22px); border: 1px solid; border-bottom-color: rgba(255,255,255,.5); border-right-color: rgba(60,60,60,.35); border-top-color: rgba(60,60,60,.35); border-left-color: rgba(80,80,80,.45); background-color: rgba(0,0,0,.2); background-repeat: no-repeat; padding: 8px 10px; font: bold .875em/1.25em "Open Sans Condensed", sans-serif; letter-spacing: .075em; color: #fff; text-shadow: 0 1px 0 rgba(0,0,0,.1); height: 30px; } form input:focus { background-color: rgba(0,0,0,.4); } ::-webkit-input-placeholder { color: #ffffff; text-transform: uppercase; } ::-moz-placeholder { color: #ffffff; text-transform: uppercase; } :-ms-input-placeholder { color: #ffffff; text-transform: uppercase; } form button[type=submit] { width: 100%; height: 50px; margin-bottom: 0; color: #cbe6e7; letter-spacing: .05em; text-shadow: 0 1px 0 #133d3e; text-transform: uppercase; background: #225556; border-top-color: #9fb5b5; border-left-color: #608586; border-bottom-color: #1b4849; border-right-color: #1e4d4e; cursor: pointer; border-radius: 5px; margin-top: 10px; } form button[type=submit]:hover { background: #3c7e7f; } #footer-container { max-width: 300px; text-align: center; margin: auto; } #footer-logo { float: left; width: 25px; } #logo-image { width: 100%; } #footer-text { float: left; font-size: 14px; padding: 5px 0px; margin-left: 4px; } #image { position: absolute; left: 330px; z-index: -1; top: 78px; float: left; } #image2 { width: 550px; position: absolute; right: 243px; top: 50px; z-index: -10; } #login-pic2 { width: 100%; } @media (max-width: 400px) { #content-box { padding: 10px; } #login-info { padding: 10px; } .input-group { margin-bottom: 15px; } form input, form button { height: 25px; } } </style> <SCRIPT type="application/javascript"> function forgotUsername() { document.getElementById("login-window").style.display="none"; document.getElementById("forgot-username").style.display=""; } function registerAcct() { document.getElementById("login-window").style.display="none"; document.getElementById("register-username").style.display=""; } function resetPassword() { document.getElementById("forgot-username").style.display="none"; document.getElementById("input-group-password").style.display="none"; document.getElementById("action").value="resetpassword"; document.getElementById("Submit").innerText ="Reset Password"; document.getElementById("links").style.display="none"; document.getElementById("links2").style.display=""; } function back() { document.getElementById("register-username").style.display="none"; document.getElementById("forgot-username").style.display="none"; document.getElementById("input-group-password").style.display=""; document.getElementById("action").value="login"; document.getElementById("Submit").innerText ="Login to your account"; document.getElementById("links").style.display=""; document.getElementById("links2").style.display="none"; document.getElementById("login-window").style.display=""; } </script> </head> <body> <div id="container"> <div id="content-box"> <div class="loginStatus" style="text-align: center;font-weight:700;font-size:x-large;color: darkred;"></div> <div id="login-info"> <div id="login-container"> <h1>Freehold Family Eye Care<br> Patient Portal Login</h1> <div id="login-window"> <form method="post" action="https://crystalpm.com/PatientPortal.jsp" name="pform" id="pform"> <fieldset> <input name="action" value="login" type="hidden" id="action"> <div class="input-group" id="input-group-username"> <label for="username" style="display:none;"> Username</label> <input id="username" placeholder="username" name="username" type="text" title="username"> </div> <div class="input-group" id="input-group-password"> <label for="password" style="display:none;"> Password:</label><input name="password" id="password" placeholder="password" class="pass" type="password" title="password"> </div> <button type="submit" value="Enter" id="Submit">Login to your account</button><br><br> <div class="input-group" id="links"> <a href="javascript:forgotUsername();">Forgot Username</a><br> <a href="javascript:resetPassword();">Reset Password</a><br> <a href="javascript:registerAcct();">Register New Account</a> </div> <div class="input-group" id="links2" style="display:none;"> <a href="javascript:back();">Back To Login</a> </div> </fieldset> </form> </div> <div id="forgot-username" style="display:none;"> <form method="post" action="https://crystalpm.com/PatientPortal.jsp" name="pform" id="pform"> <fieldset> <input name="action" value="forgotusername" type="hidden"> <div class="input-group"> <label for="email" style="display:none;"> Email</label> <input id="email" placeholder="email" name="email" type="text" title="email"> </div> <button type="submit" value="Enter" id="Submit-ForgotUser">Send Username To Email</button> <br><br> <div class="input-group" id="links2"> <a href="javascript:back();">Back To Login</a> </div> </fieldset> </form> </div> <div id="register-username" style="display:none;"> <form method="post" action="https://crystalpm.com/PatientPortal.jsp" name="pform2" id="pform2"> <fieldset> <input name="action" value="forgotusername" type="hidden"> <input name="register" value="1" type="hidden"> <div class="input-group"> <label for="email" style="display:none;"> Email</label> <input id="email" placeholder="email" name="email" type="text" title="email"> </div> <button type="submit" value="Enter" id="Submit-ForgotUser">Register, Verify Account Exists Using Email</button> <br><br> <div class="input-group" id="links3"> <a href="javascript:back();">Back To Login</a> </div> </fieldset> </form> </div> </div> </div> </div> <div id="footer"> <div id="footer-container"> <span id="footer-logo"> <img id="logo-image" title="Crystal PM Icon" alt="Company Logo" src="./crystalico.png"> </span> <span id="footer-text"> Powered by Crystal Practice Management </span> </div> </div> </div> </body> </html>