<% const numFields = 3 dim errorArray() redim preserve errorArray(numFields) if Request.Form("submitted") = "yes" then Dim cname, email, phone, message, re Dim objCDO set re = New RegExp cname = Request.Form("contact_name") email = Request.Form("email") phone = Request.Form("phone") message = Request.Form("message") ErrorMsg = "" 'Name re.Pattern = "^[^0-9\/><\.,\\!\^\$\*\+\?@#%&\(\);:\[\]\{\}=""']+$" re.Global = True re.IgnoreCase = True results = re.Test(cname) if results then errorArray(0) = "False" else errorArray(0) = "True" ErrorMsg = "Name
" end if if Request.Form("respond_by") = "email" then 'Email if Len(email) <> 0 then errorArray(1) = "False" else errorArray(1) = "True" ErrorMsg = ErrorMsg & "Email Address
" end if elseif Request.Form("respond_by") = "phone" then if Len(phone) = 0 then errorArray(1) = "True" ErrorMsg = ErrorMsg & "Phone
" end if end if 'message if message = "" then errorArray(2) = "True" ErrorMsg = ErrorMsg & "Message
" end if 'Here is where we insert new code to invoke CDONTS 'This line invokes the object using the name objCDO if ErrorMsg = "" then Set objCDO = Server.CreateObject("CDONTS.NewMail") objCDO.From = "info@elderplanningall.com" objCDO.To = "info@elderplanningall.com" objCDO.Subject = "Question or comment from " & cname objCDO.Body = "Name: " & cname & vbCrlf & _ "Email: " & email & vbCrlf & _ "Message: " & message & vbCrlf objCDO.BodyFormat = 1 objCDO.MailFormat = 1 objCDO.Send ConfirmMsg = "Thank you, " & cname & "! We will respond as soon as possible." end if end if %> Elder Planning Alliance - Offering counseling and Medicaid filing to families seeking nursing home care

Contact Information

<% if ErrorMsg <> "" then %>
You left the following fields blank:

<%= ErrorMsg %>
<% end if %> <% if ConfirmMsg <> "" then %>
<%= ConfirmMsg %>
<% end if %>

Office Hours:

Monday through Thursday: 9:00 A.M. to 5:00 P.M. and 9:00 to 3:00 P.M. Friday

Telephone:

Office: (727) 372-2702
Toll-free: (866) 372-2702

Fax:

(727) 376-8812

Email:

info@elderplanningall.com

Questions?

Use this form to contact us if you have any questions or comments. We will respond as soon as possible.


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