<% ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' ' Email Form Handler ' Versions: 1.0 - 4/9/2008 ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' IF Request("st")=1 THEN fname=Request.Form("fname") lname=Request.Form("lname") phone=Request.Form("phone") address=Request.Form("address") city=Request.Form("city") state=Request.Form("state") zip=Request.Form("zip") comments=Request.Form("comments") strReturnPath=Request.Form("strReturnPath") strHost=Request.Form("strHost") strFrom="inquiry@americanbeautyandwellness.com" strTo=Request.Form("strTo") strSubject=Request.Form("strSubject") strReplyTo=Request.Form("strReplyTo") strBody="" strBody = strBody & "Another doctor as inquired about their listing on the website." & vbcrlf strBody = strBody & " " & vbcrlf strBody = strBody & "Name: " & fname & " " & lname & vbcrlf strBody = strBody & "Phone: " & phone & vbcrlf strBody = strBody & "Address: " & address & vbcrlf strBody = strBody & " " & city & ", " & state & " " & zip & vbcrlf strBody = strBody & "Email: " & strReplyTo & vbcrlf strBody = strBody & "--------------------------------------------------" & vbcrlf strBody = strBody & "Comments: " & comments & vbcrlf ' CALL EMAIL SEND FUNCTION (Empty Variables Filled in Function) Call Send_Site_Email(strHost,strFrom,strTo,strBcc,strSubject,strReplyTo,strBody) ' RETURN TO DESIRED WEBSITE PAGE (Default to Refering Page if Empty) Response.Redirect strReturnPath & "?st=0" END IF %> American Beauty & Wellness
American Beauty & Wellness
 
<%IF Request("st")<>"0" THEN%>
If you are a patient please do not use this form.  Click here to find a doctor.

Are you a doctor who you like to be listed with American Beauty and Wellness?  We offer a no obligation, no cost trial period for listings.  Contact us for more information using the form below.
 

Doctor Listing Inquiry

First Name *

Last Name *

 Phone *

 Address

City / State / Zip
/ /
E-mail *

Comments and/or Questions:

<%ELSE%>

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<%END IF%>

 
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