<% Option Explicit %> <% dim strFirstName dim strLastName Dim strEmail dim strDate dim strTime dim strPhone dim strAppointmentfor dim strcomments dim strdoc dim nId dim count dim count1 DIM strTransactionStatus dim Rs dim strBodyPatch dim QThx dim strSql dim strsubject dim strqryinsert dim rdBtnVal dim errr 'if TestCaptcha("ASPCAPTCHA", Request.Form("captchacode")) then ' errr="" ' Init ' else ' errr="You entered the wrong code." ' 'Response.Write("You entered the wrong code.") ' end if Sub Init QThx=Request.QueryString("thx") strTransactionStatus="" Connect Set Rs=Server.CreateObject("ADODB.RecordSet") If Trim(QThx)<>"" Then GetFormData InsertData Mailbody 'This function was commented, uncommented by - akshay 06 Jan 07 Response.Redirect "confirmation.asp?dt=" & strDate & "&tm=" & strTime & " " End If Set Rs=Nothing Disconnect End Sub Sub GetFormData strFirstName=Request.Form("txtfirstname") strLastName=Request.Form("txtlastname") strEmail=Request.Form("txtemail") strDate=Request.Form("cmbappointmentinYear")& "/" & Request.Form("cmbappointmentinMonth")& "/" &Request.Form("cmbappointmentinDay") strTime=Request.Form("cmbappointmenthour")& ":" & Request.Form("cmbappointmentmin")& "" &Request.Form("cmbappointmentampm") strAppointmentFor=Request.Form("txtappointment") strAppointmentfor = Replace(strAppointmentfor,"'","'") strcomments=Request.Form("txtcomments") strcomments=Replace(strcomments,"'","'") nId=GetPrimaryKey("AppointmentDetails","id",Rs) strdoc=Request.Form("cmbdoctorname") rdBtnVal=Request.Form("TelNo") If rdBtnVal = "0" Then strPhone = Request.Form("txttelephone1")& "-" & Request.Form("txttelephone2") & "-" & Request.Form("txttelephone3") ElseIf rdBtnVal = "1" Then strPhone = Request.Form("txtUSTelephone") End If End Sub Sub GenerateSqlQuery 'Query modified by akshay strSql="Insert Into AppointmentDetails(id,firstname,lastname,emailid,appointmentdate,appointmenttime,phone,appointmentfor,comments,doctorsname,RegistrationDateTime)" & _ "Values(" & nId & ",'" & strFirstName & "','" & strLastName & "','" & strEmail & "','" & strDate & "','" & strTime & "','" & strPhone & "','" & strAppointmentFor & "','" & strcomments & "','"& strdoc &"','" & Now() & "')" 'Response.Write strSql 'Response.End End Sub sub Mailbody Dim strCCMail strAppointmentfor = Replace(strAppointmentfor,"'","'") strcomments=Replace(strcomments,"'","'") strCCMail = "rachel@coem.com,officeassistant@coem.com,frontdesk@coem.com,ari@coem.com" strsubject="Appointment Request for :" & strFirstName & " " & strLastName& " " strBodyPatch = "" &_ "" &_ "" &_ "" &_ "" strBodyPatch= strBodyPatch & "

Thank you for scheduling a Thermoscan.

" strBodyPatch= strBodyPatch & "
Your details are as follows:

" strBodyPatch= strBodyPatch & "First Name: " & strFirstName& "
" strBodyPatch= strBodyPatch & "Last Name:" & strLastName& "
" strBodyPatch= strBodyPatch & "Email: " & strEmail &"
" strBodyPatch= strBodyPatch & "Date: " & convertYYYYMMDDtoMMDDYYYY(strDate,false) &"
" strBodyPatch= strBodyPatch & "Time: " & strTime &"
" strBodyPatch= strBodyPatch & "Phone:" & strPhone& "
" strBodyPatch= strBodyPatch & "Appointment for: " & strAppointmentFor &"
" strBodyPatch= strBodyPatch & "Comments: " & strcomments &"
" strBodyPatch= strBodyPatch & "Doctor's Name: " & strdoc &"
" strBodyPatch= strBodyPatch & "

The appointment request you just made for a Thermogram at the Center for Occupational and Environmental " &_ "Medicine via the Early Cancer Detection website, will be received by the staff and once they check the requested " &_ "time against the actual schedule they will call you and confirm the same.

"&_ "

Please call the office should you not hear from someone with in 48 hours Monday-Friday.

"&_ "

Thank you for making an appointment request. We look forward to serving your health care needs.

"&_ "

For additional information and treatment programs please visit www.coem.com

" If Err.number=0 Then Call SendMail (strEmail,"info@earlycancerdetection.com",strCCMail,"",strSubject,strBodyPatch) 'Call SendMail ("sheila@coem.com", "appointments@coem.com", "insurance@coem.com","ari@coem.com", strEmail, strSubject, strBodyPatch) 'Call Sendmail ("sheila@coem.com", "appointments@coem.com", "ptcoordinator@coem.com","", strEmail, strSubject, strBodyPatch) end if end sub Sub InsertData GenerateSqlQuery Con.Execute strSql End Sub function TestCaptcha(byval valSession, byval valCaptcha) dim tmpSession valSession = Trim(valSession) valCaptcha = Trim(valCaptcha) if (valSession = vbNullString) or (valCaptcha = vbNullString) then TestCaptcha = false else tmpSession = valSession valSession = Trim(Session(valSession)) Session(tmpSession) = vbNullString if valSession = vbNullString then TestCaptcha = false else valCaptcha = Replace(valCaptcha,"i","I") if StrComp(valSession,valCaptcha,1) = 0 then TestCaptcha = true else TestCaptcha = false end if end if end if end function %> Cancer | breast cancer | breast cancer detection | early breast cancer detection | breast cancer prevention treatment
 
Connection Between the Environment and Breast Cancer

 

 

 

 

 
Please Click here to go to the map and driving directions to the office


Please fill in the following details to schedule an appointment:


" & vbCrLf) end if %> <% 'response.Write errr %>
First Name


:
Last Name


:
Email Address


:
     
Disclaimer: 'Thermograms are only performed Monday - Thursday'
     
Requested Appointment Date

:      
 
Appointments for thermascans are available according to this schedule:

Mon, Tue, Thurs - 8:30, 3:30, 4:30

Wed - 8:30, 9:15, 10:00, 10:45, 1:15, 2:00, 2:45, 3:30, 4:15

Fri - Not Available

Allow 45 minutes per scan.
     
     
Requested Appointment Time


:
Doctor's Name


:
Telephone Number


:
- -

Reason for an Appointment :
Comments :

  Please Enter The Verification Code To Prevent Spam
 
   

This is not a live system and your Appointment Date and Time are not set until you receive confirmation from the COEM Staff. Thank You!

    
<% if not IsEmpty(Request.Form("cmdSubmit")) then 'Response.Write("
") if TestCaptcha("ASPCAPTCHA", Request.Form("captchacode")) then Init else Response.Write("You entered the wrong code.") end if 'Response.Write("