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Health Net


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Medicare


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Preferred One


Primecare of Corona (HMO)


United Health Care


        

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<% Dim sTo, sFrom, Subject, sMailServer, sBody, saved saved=0 if request("txtName") <> "" then savedata end if sub savedata on error resume next Dim strINS_Stmt Dim vartxtName, vartxtEmail, vartxtDayPh, vartxtEvePh, vartxtSubject, vartxtMessage, vartxtContact_Source vartxtName = Trim(Request("txtName")) vartxtEmail = Trim(Request("txtEmail")) vartxtDayPh = Trim(Request("txtdayPh")) vartxtEvePh = Trim(Request("txtEvePh")) if vartxtDayPh = "xxx-xxx-xxxx" then vartxtDayPh="" end if vartxtEvePh = Trim(Request("txtEvePh")) if vartxtEvePh = "xxx-xxx-xxxx" then vartxtEvePh="" end if vartxtMessage = Trim(Request("txtMessage")) vartxtContact_Source = Trim(Request("txtContact_Source")) mes = "" IsSuccess = false sFrom = "ADMINISTRATION@QualityCarefp.com" sTo = "Questions@Qualitycarefp.com" sSubject = "New Inquiry" sMailServer = "mail-fwd" if vartxtDayPh = "" Then vartxtDayPh = "Not supplied" End If if vartxtEvePh = "" Then vartxtEvePh = "Not supplied" End If sBody = "Below are details for new contact message" &_ "

Name : " & vartxtName & "

Email ID : " & vartxtEmail &_ "

Daytime Phone Number : " & vartxtdayPh & "

Evening Phone Number : " & vartxtEvePh &_ "

Contact Source : " & vartxtContact_Source &_ "

Message : " & vartxtMessage Set objMail = Server.CreateObject("CDO.Message") Set objConf = Server.CreateObject("CDO.Configuration") Set objFields = objConf.Fields With objFields .Item("http://schemas.microsoft.com/cdo/configuration/sendusing") = 2 .Item("http://schemas.microsoft.com/cdo/configuration/smtpserver") = sMailServer .Item("http://schemas.microsoft.com/cdo/configuration/smtpconnectiontimeout") = 10 .Item("http://schemas.microsoft.com/cdo/configuration/smtpserverport") = 25 .Update End With With objMail Set .Configuration = objConf .From = sFrom .To = sTo .CC = "Kat.holman@QualityCarefp.com" .Subject = sSubject .HTMLBody = sBody End With Err.Clear on error resume next objMail.Send Set objFields = Nothing Set objConf = Nothing Set objMail = Nothing sFrom = "ADMINISTRATION@QualityCarefp.com" sTo = vartxtEmail sSubject = "Your Inquiry has been submitted" sMailServer = "mail-fwd" sBody = "Thank you for submitting your question(s) to the Quality Care Family Practice office staff. Someone will contact you within 1 business day." &_ "

If you want to make an appointment, please click here." &_ "

Thank you," &_ "
Quality Care Family Practice Staff" Set objMail = Server.CreateObject("CDO.Message") Set objConf = Server.CreateObject("CDO.Configuration") Set objFields = objConf.Fields With objFields .Item("http://schemas.microsoft.com/cdo/configuration/sendusing") = 2 .Item("http://schemas.microsoft.com/cdo/configuration/smtpserver") = sMailServer .Item("http://schemas.microsoft.com/cdo/configuration/smtpconnectiontimeout") = 10 .Item("http://schemas.microsoft.com/cdo/configuration/smtpserverport") = 25 .Update End With With objMail Set .Configuration = objConf .From = sFrom .To = sTo .cc= "Kat.Holman@Qualitycarefp.com; Dr.Sathya@Qualitycarefp.com" .Subject = sSubject .HTMLBody = sBody End With Err.Clear on error resume next objMail.Send Set objFields = Nothing Set objConf = Nothing Set objMail = Nothing saved = 1 end sub %> <%if saved = 1 then %>

 Thank you for contacting Quality Care Family Practice.

 You will receive a confirmation email message shortly at the email address you provided.

<%else %>
Your Name:
Your E-mail Address:
Daytime Phone Number:
Evening Phone Number:
Message:
How did you hear about us?:
<%end if%>


QUALITY CARE FAMILY PRACTICE
2083 Compton Ave,
Suite 105,
Corona, CA 92881
Phone: (951)808-3000
Fax: (951)403-6626
Office Hours:
MON-FRI: 9AM-5PM
SAT: By Appointment Only

After Hours:
On Call 24 Hours

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