WellNet Healthcare (424) -- WellNet Healthcare OptIn (252)

meeting - WellNet Schedule Meeting Form

FormID: 364 AccountID: 252

RESPONSIVE config-meeting.php file: <?php $arHandlebarView["template"] = "form-whatever"; if ($useThanks!=true) { $arHandlebarView["headerText"] = 'Contact Us For More Information'; $arHandlebarView["descriptionText"] = $reqmessage.'<p>We would like the opportunity to provide you with more information. Please fill in the simple form below, select the <strong>Submit</strong> button, and we will get back to you shortly. </p>'; $arHandlebarForm["hiddenSection"][] = array("name"=>"FormID","value"=>"0000000364"); $arHandlebarForm["hiddenSection"][] = array("name"=>"AID","value"=>"0000000252"); $arHandlebarForm["hiddenSection"][] = array("name"=>"ref","value"=>$_REQUEST['ref']); $arHandlebarForm["hiddenSection"][] = array("name"=>"ET","value"=>$_REQUEST['ET']); $arHandlebarForm["hiddenSection"][] = array("name"=>"FT","value"=>$_REQUEST['FT']); if ($_REQUEST['PID']<>"") $_REQUEST['Num']=$_REQUEST['PID']; if ($_REQUEST['Num']<>"") $arHandlebarForm["hiddenSection"][] = array("name"=>"PID","value"=>$_REQUEST['Num']); $arContactSection["FirstName"] = array("type"=>"input","required"=>1,"label"=>" First Name:","name"=>"FirstName","id"=>"FirstName","maxlength"=>24,"value"=>$_REQUEST["FirstName"]); $arContactSection["LastName"] = array("type"=>"input","required"=>1,"label"=>" Last Name:","name"=>"LastName","id"=>"LastName","maxlength"=>32,"value"=>$_REQUEST["LastName"]); $arContactSection["Email"] = array("type"=>"input","required"=>1,"label"=>" Email:","name"=>"Email","id"=>"Email","maxlength"=>64,"value"=>$_REQUEST["Email"]); $arContactSection["Phone"] = array("type"=>"input","required"=>1,"label"=>" Phone:","name"=>"Phone","id"=>"Phone","maxlength"=>16,"value"=>$_REQUEST["Phone"]); $arHandlebarForm["contactSection"] = $arContactSection; $arHandlebarForm["questionSection"] = $arQuestionSection; $arHandlebarView["form"] = array("name"=>"meeting_form","id"=>"meeting_form","action"=>"/contact/form_meeting","method"=>"post","onsubmit"=>$formOnSubmit,"submitID"=>"submitform","fields"=>$arHandlebarForm); } else { $arHandlebarView["headerText"] = 'Thanks for your time!'; $arHandlebarView["descriptionText"] = '<P>Many thanks for contacting us. A representative will be responding to your on-line request shortly. We appreciate your business and will do our best to serve your needs! </p>'; $arHandlebarView["form"] = ''; }

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