<% '****************************************************************************** '* COPYRIGHT NOTICE * '****************************************************************************** '* Copyright 2002, Web Development Group Pty Ltd. All Rights Reserved * '* http://www.wdg.com.au info@wdg.com.au 03 9620 4111 * '****************************************************************************** '****************************************************************************** ' Name: ***** ' Purpose: ***** ' ' Notes: ' ' $Header: /online/SONRAY/admin/main.asp 3 6/08/03 2:08p Struong $ '****************************************************************************** Response.Buffer = True %> <% ' Dim variables 'Dim objMember, intUsers_ID 'Dim strErrorMessage dim objDatabase ' Create objects Set objDatabase = OpenDB() Set objMember = New clsMember %> <% Dim strForm_PatientName, strErrorMsg,strForm_DoctorName,strForm_DoctorSurgery,strForm_Phone,strForm_PatientRefNo,strForm_CeaseType 'dim blnSuccess Dim strBodyMsg, objEmail, blnResult Dim strForm_Day, strForm_Month, strForm_Year Dim SQL ' Process if form was submitted If UCase(Request.Form("hdnSubmit")) = "YES" Then ' Store Form Variables strForm_FirstName = Trim(Request.Form("FirstName")) strForm_SurName = Trim(Request.Form("SurName")) strForm_Phone = Trim(Request.Form("Phone")) strForm_Email = Trim(Request.Form("Email")) strForm_Comments = Trim(Request.Form("Comments")) Call CheckField(strErrorMsg, strForm_FirstName, " - Please enter the First Name
", strBGColor_DoctorName) Call CheckField(strErrorMsg, strForm_SurName, " - Please enter the Surname
", strBGColor_DoctorSurgery) Call CheckField(strErrorMsg, strForm_Phone, " - Please enter the Contact Phone Number
", strBGColor_Phone) Call CheckField(strErrorMsg, strForm_Email, " - Please enter the Email address
", strBGColor_Phone) Call CheckField(strErrorMsg, strForm_Comments, " - Please enter your Comments
", strBGColor_Phone) If strForm_Email <> "" Then If IsValidEmailAddress(strForm_Email) = False Then strErrorMsg = strErrorMsg & " - Please enter a valid Email Address
" 'strBGColor_Fax = Application("BGColor_invalid") End If End If If strForm_Phone <> "" Then If NOT IsNumeric(Replace(strForm_Phone," ","")) Then strErrorMsg = strErrorMsg & " - Please enter a valid Contact Phone Number
" 'strBGColor_Phone = Application("BGColor_invalid") End If End If ' If there are no errors If strErrorMsg = "" Then ' Put everything in session for preview session("FirstName") = strForm_FirstName session("SurName") = strForm_SurName session("Phone") = strForm_Phone session("Email") = strForm_Email session("Comments") = strForm_Comments strBodyMsg = "Contact Us Form Details" & Chr(10) & _ "--------------" & Chr(10) & _ "First Name : " & session("FirstName") & Chr(10) & _ "Surname : " & session("SurName") & Chr(10) & _ "Contact Phone Number : " & session("Phone") & Chr(10) &Chr(10) & _ "Email : " & session("Email") & Chr(10) & _ "Comments : " & session("Comments") & Chr(10) & _ "http://www.qml.com.au/" ' Create instance of Email Class Set objEmail = New clsEmail With objEmail ' setup configuration .MailComponent = application("smtp_component") .MailServer = application("smtp_server") ' email sent from .FromName = "Symbion" .FromEmail = "info@qml.com.au" .ContentType = "text/html" .Priority = "3" '.AddRecipient "info@qml.com.au", "Contact Us" '.AddRecipient "kevin.thomas@qml.com.au", "Kevin Thomas" .AddRecipient "nick@newlight.com.au", "QML Contact Us" .Subject = "Contact Us Form" .TextBody = strBodyMsg blnResult = .Send() End With ' display response (hidden from view) response.write "" ' Test if mail successfully sent If blnResult = False Then Response.Write " Mailer Response:"& objEmail.Response &"" strErrorDesc = " Your message could not be sent. " & _ "Please ensure your E-mail address is valid.
" End If blnSuccess = true ' Insert Into Log table SQL = "exec p_FORMLOGS__Insert @DrName = '" & session("FirstName") & " " & session("SurName") & "'," SQL = SQL & "@FormType = 'Contact Us Form'," SQL = SQL & "@DateSubmitted = '" & now() & "'" 'response.write sql objDatabase.Execute(SQL) '----------------------------------------------------------------------------------------------------------------------- 'Clear Session variables for values '----------------------------------------------------------------------------------------------------------------------- 'Register Patient Sessions session("AccessOnline") = "" session("AccessWarfarin") = "" session("AccessHealth") = "" session("AccessVaccine") = "" session("AccessMedical") = "" session("DoctorName") = "" session("DoctorSurgery") = "" session("Phone") = "" session("DrCode") = "" session("PatientName5") = "" session("Day") = "" session("Month") = "" session("Year") = "" session("Gender") = "" session("PatientAddress") = "" session("PatientHomeNo") = "" session("SecondNo") = "" session("FirstName") = "" session("SurName") = "" session("Phone") = "" session("Email") = "" session("Comments") = "" 'Deregister SEssion session("DoctorName") = "" session("DoctorSurgery") = "" session("Phone") = "" session("PatientName") = "" session("Day") = "" session("Month") = "" session("Year") = "" session("PatientRefNo") = "" session("CeaseType") = "" 'Order Report Sessions session("DoctorName") = "" session("DoctorCode") = "" session("DoctorSurgery") = "" session("DoctorAddress") = "" session("DoctorSuburb") = "" session("DoctorPcode") = "" session("DoctorState") = "" session("Phone") = "" session("Fax") = "" session("Report") = "" session("PatientName1") = "" session("Day") = "" session("Month") = "" session("Year") = "" session("Gender") = "" session("Country1") = "" session("Country2") = "" session("Country3") = "" session("Country4") = "" session("Country5") = "" session("Country6") = "" session("Country7") = "" session("Country8") = "" session("Country9") = "" session("Country10") = "" session("Travel1") = "" session("Travel2") = "" session("Travel3") = "" session("Travel4") = "" session("Travel5") = "" session("Travel6") = "" session("Travel7") = "" session("Travel8") = "" session("Travel9") = "" session("Travel10") = "" session("ReadandAgreed") = "" session("Email") = "" 'Order Vaccines session("DoctorName") = "" session("ContactName") = "" session("DoctorSurgery") = "" session("Phone") = "" session("PatientName") = "" 'Order products session("DoctorName") = "" session("ContactName") = "" session("DoctorSurgery") = "" session("Phone") = "" session("ReadandAgreed") = "" End If Else If session("FirstName") <> "" Then strForm_FirstName = session("FirstName") End If If session("SurName") <> "" Then strForm_SurName = session("SurName") End If If session("Phone") <> "" Then strForm_Phone = session("Phone") End If If session("Email") <> "" Then strForm_Email = session("Email") End If If session("Comments") <> "" Then strForm_Comments = session("Comments") End If End If %>

Contact Us

<% If blnSuccess Then %>

Thank you for your feedback. We will endeavour to respond to you as soon as possible.



<% Else %> <% If strErrorMsg <> "" Then %>
Please correct the following errors, and re-submit:
<%=strErrorMsg%>

<% End If %>

QML Pathology welcomes any feedback, comments or questions with regards to our service. All correspondence is attended to with priority during business hours (Monday to Friday), with the exception of weekends and public holidays. If the matter is urgent please call our Central Laboratory on (07) 3121 4444.


*

Denotes a mandatory field

* First Name :

* Surname :

* Contact Phone Number :

* Email :

* Comments :

 
 
<% End If %>
<% CloseObject(objDatabase) CloseObject(objMember) %>
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