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<% function FieldOK(FieldName) if Request.Form(FieldName) = "" and Request.Form("send") then FieldOK = false else FieldOK = true end if end function function FieldWithDefaultOK(DefaultValue, FieldName) if Request.Form(FieldName) = DefaultValue and Request.Form("send") then FieldWithDefaultOK = false else FieldWithDefaultOK = true end if end function %>

<%if Request.Form("send") <> "" then if Request.Form("Prenom") = "" or FieldWithDefaultOk("Jour", "NaissanceJour") = false or FieldWithDefaultOk("Mois", "NaissanceMois") = false or FieldWithDefaultOk("Année", "NaissanceAnnee") = false or Request.Form("CodeRegional") = "" or Request.Form("Tel1") = "" or Request.Form("Tel2") = "" or Request.Form("clinique") = "Choose" or Request.Form("Courriel") = "" then Response.Write("Please fill all mandatory fields *") end if end if if Request.Form("Prenom") <> "" and FieldWithDefaultOk("Jour", "NaissanceJour") and FieldWithDefaultOk("Mois", "NaissanceMois") and FieldWithDefaultOk("Année", "NaissanceAnnee") and Request.Form("CodeRegional") <> "" and Request.Form("Tel1") <> "" and Request.Form("Tel2") <> "" and Request.Form("clinique") <> "Choose" and Request.Form("Courriel") <> "" then Set Mailer = Server.CreateObject("CDONTS.NewMail") ' Variable ajoutée par Max Dim bodyMail ' Construire le contenu du mail bodyMail = bodyMail & "Client First and Last Names: " & Request.Form("Titre") & " " & Request.Form("Prenom") & " " & Request.Form("Nom") & vbCrLf & vbCrLf bodyMail = bodyMail & "Date of birth : " & Request.Form("NaissanceJour") & " " & Request.Form("NaissanceMois") & " " & Request.Form("NaissanceAnnee") & vbCrLf & vbCrLf bodyMail = bodyMail & "Telephone: " & Request.Form("CodeRegional") & "-" & Request.Form("Tel1") & "-" & Request.Form("Tel2") & vbCrLf & vbCrLf bodyMail = bodyMail & "Email: " & Request.Form("Courriel") & vbCrLf & vbCrLf bodyMail = bodyMail & "Contact lens wearer: " & Request.Form("CLwearer") & vbCrLf & vbCrLf bodyMail = bodyMail & "Appointment: " & Request.Form("RVannee") & "-" & Request.Form("RVmois") & "-" & Request.Form("Rvjour") & "-" & Request.Form("RVheure") & vbCrLf & vbCrLf bodyMail = bodyMail & "Remarks: " & Request.Form("remarques") & vbCrLf & vbCrLf bodyMail = bodyMail & "Wants to receive newsletters and promotionals: " & Request.Form("Newsletter") & vbCrLf Mailer.Body = bodyMail ' Envoyer le mail Mailer.From = Request.Form("Courriel") Mailer.To = "info@keeferplaceoptometry.com" ' Mailer.Cc = Request.Form("Courriel") Mailer.Subject = "Appointment request - ABC" Mailer.Send %>

// Your form has been sent.
One of our representatives will contact you to confirm the appointment or to suggest another date and time.
Thank You! //

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If you would like schedule an eye exam, you can either phone our office 604-899-6069 or fill out the form below. Our staff is ready to assist you.
All the fields followed by a * are mandatory.

Title: 
First name*:  " /> <% if FieldOk("Prenom") = false then Response.Write("Enter your First name") end if %>
Last name*: " /> <% if FieldOk("Prenom") = false then Response.Write("Enter your Last name") end if %>
Day time telephone*:  " /> " /> " /> <% if FieldOk("CodeRegional") = false or FieldOk("Tel1") = false or FieldOk("Tel2") = false then Response.Write("Telephone no. mandatory") end if %>
E-mail*:  " /> <% if FieldOk("Courriel") = false then Response.Write("E-mail mandatory") end if %>
(for confirmation email only, will not be given to a third party)
Are you a contact lens wearer: Yes /> No />
Date wanted:
Time wanted:  " />
Clinic*:  <% if Request.Form("clinique") = "Choose" then Response.Write("Choose a clinic") end if %>
Comments:
Would you be interested in being kept informed of clinic promotions, offers or updates? Yes No
 
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