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<div class="register_login"> <div class="clear spacer"></div> <div class="login_area stack-md"> <h3>Existing Customer Login</h3> <div class="form_box_wrapper"> <div class="login_box"> <div class="creds_input"> <div class="login_form std_form2 stack-md"> <form method="post" action="https://www.cliniciansreport.org/products.php?save_cart=&amp;current=&amp;next=https%3A%2F%2Fwww.cliniciansreport.org%2Fproducts.php%3Fsave_cart%3D%26current%3D"> <input type="hidden" name="form_type" value="login" /> <table width="100%" border="0" cellspacing="0" cellpadding="0"> <tr> <td class="lbl"><label>Email</label></td> <td><input autocomplete="username" type="text" name="email" value="" class="inp" /></td> </tr> <tr> <td><label>Password</label></td> <td> <input autocomplete="password" type="password" name="password" class="inp" /> </td> </tr> <tr> <td>&nbsp;</td> <td> <div class="extra"><a href="https://www.cliniciansreport.org/lost_password.php">Forgot your password?</a></div> <div class="extra"><input type="checkbox" name="remember_me" value=1" checked /> Keep me logged in on this computer</div> <br /> <button type="submit" class="luna-btn primary_color btn smaller">Login</button> </td> </tr> </table> </form> </div> </div> <div class="box_bot"></div> </div> </div> </div> <div class="register_area stack-md"> <h3>Or New Customer Register</h3> <div class="register_box"> <div class="creds_input"> <div class="register_form std_form2 stack-md"> <form method="post" action="https://www.cliniciansreport.org/products.php?save_cart=&amp;current=&amp;next=https%3A%2F%2Fwww.cliniciansreport.org%2Fproducts.php%3Fsave_cart%3D%26current%3D"> <input type="hidden" name="form_type" value="register" /> <div class="pre_account_info"></div> <div class="field_box wicon"> <input type="text" autocomplete="email" name="email" placeholder="Email" value="" class="inp" /> <i class="icon-envelope"></i> </div> <div class="tooltip_overlay t2 field_box wicon"> <input id="password_create" autocomplete="new-password" type="password" placeholder="Create Password" name="password" class="inp" value="" /> <i class="icon-lock"></i> <a style="text-decoration: none;" href="javascript://" onclick="return false" tabindex="-1" class="tooltip righty"><img src="https://www.cliniciansreport.org/templates/default/img/help.png" style="vertical-align: text-bottom;" /><span> Password must be at least 6 characters in length, must contain at least one capital letter, and must contain at least one number or symbol </span></a> <span class="jmess tooltip righty tooltip2"></span> </div> <div class="tooltip_overlay field_box wicon"> <input type="password" autocomplete="new-password" placeholder="Confirm Password" id="password_match" name="confirm_password" class="inp" value="" /> <i class="icon-lock"></i> <span class="jmess tooltip righty"></span> </div> <div class="field_box"> <div class="stack-md wicon" style="float: left; width: 49%;"> <input type="text" autocomplete="given-name" name="first_name" placeholder="First Name" value="" class="inp" /> <i class="icon-user"></i> </div> <div class="stack-md wicon" style="float: right; width: 49%;"> <input type="text" autocomplete="family-name" name="last_name" placeholder="Last Name" value="" class="inp" /> <i class="icon-user"></i> </div> <div class="clear"></div> </div> <div class="field_box wicon"> <input type="text" name="phone" autocomplete="phone" placeholder="Phone" value="" class="inp" /> <i class="icon-phone"></i> </div> <div> <label>Security Code</label> <script src='https://www.google.com/recaptcha/api.js'></script><div class="g-recaptcha" data-sitekey="6LeABR4UAAAAAAS3siXOX7yD5kD471eWdNHKXQEO"></div> </div> <div> <br /><button type="submit" class="luna-btn primary_color btn">Register</button> </div> <div class="clear"></div> </form> </div> </div> <div class="box_bot"></div> </div> </div> <div class="clear spacer"></div> </div>

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