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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 FieldWithDefaultOk("Année", "ExamenAnnee") = false or FieldWithDefaultOk("Mois", "ExamenMois") = false 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 FieldWithDefaultOk("Annee", "ExamenAnnee") and FieldWithDefaultOk("Mois", "ExamenMois") and (Request.Form("typeJetableDroit") <> "" or Request.Form("typeJetableGauche") <> "" ) 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 & "Last Eye Exam: " & Request.Form("ExamenMois") & " " & Request.Form("ExamenAnnee") & vbCrLf & vbCrLf bodyMail = bodyMail & "Product Name: " & Request.Form("produit") & vbCrLf & vbCrLf bodyMail = bodyMail & "Eye: " & Request.Form("typeJetableDroit") & ", " & Request.Form("typeJetableGauche") & vbCrLf & vbCrLf bodyMail = bodyMail & "Re-order for: " & Request.Form("Quantite") & vbCrLf & vbCrLf bodyMail = bodyMail & "Number of boxes : " & Request.Form("boites") & vbCrLf & vbCrLf bodyMail = bodyMail & "Pick-up Location: " & Request.Form("clinique") & 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 order has been sent.
We will contact you as soon as your contact lenses are ready for pick-up.
Thank You! //

<% else %>

Our office provides two convenient ways of ordering Contact Lenses. You can either phone our office
604-899-6069
or fill out the form below. Our staff is ready to assist you.

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 %>
Date of birth*:  <% if FieldWithDefaultOk("Day", "NaissanceJour") = false or FieldWithDefaultOk("Month", "NaissanceMois") = false or FieldWithDefaultOk("Year", "NaissanceAnnee") = false then Response.Write("Date mandatory") 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)
When was your last eye exam?  <% if FieldWithDefaultOk("Mois", "examenMois") = false or FieldWithDefaultOk("Année", "examenAnnee") = false then Response.Write("Date mandatory") end if %>
An annual eye exam is recommended to all contact lenses users.
Type of lenses required*:  Name of product:   " /> <% if ((FieldOk("typeJetableDroit") = false and FieldOk("typeJetableGAuche") = false) or (FieldOk("Quantite") = false) or FieldOk("produit") = false or FieldOk("boites") = false) and (FieldOk("typeRegulierOeilDroit") = false and FieldOk("typeRegulierOeilGauche") = false) then Response.Write("Mandatory Fields") end if %>
  Right Eye /> Left Eye />
  Quantity: 1 year /> 6 months /> 3 months />
  OR number of boxes: " />
Pick-up location*:  <% 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
 
<% end if %>