...

View Full Version : Help - Not Receiving Form Results



mckenzie
08-02-2004, 06:17 PM
I have a client that has several form on there website. for some reason this one is not working. can any one take a look at this asp code and tell me whats wrong. The form is directed to this page...... Heres the code. Thanks in advance for all the help!

<%
strMsg = strMsg & "<form>"
strMsg = strMsg & "<table width='780' border='0' align='center' cellpadding='0' cellspacing='0'>"
strMsg = strMsg & "<tr><td class='main'>&nbsp;</td></tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td class='main'><strong>Fen-Phen Application </strong></td></tr><tr><td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr> "
strMsg = strMsg & "<td><u class='main'>CLIENT INFORMATION</u></td></tr><tr><td>&nbsp;</td></tr>"


strMsg = strMsg & "<tr> "
strMsg = strMsg & "<td>Broker Code: "&REQUEST("BrokerCode")&"</td></tr><tr><td>&nbsp;</td></tr>"

strMsg = strMsg & "<tr valign='top'>"
strMsg = strMsg & "<td><table width='700' height='202' border='0' cellpadding='0' cellspacing='0'>"
strMsg = strMsg & "<tr valign='top' width='78'>"
strMsg = strMsg & "<td class='main2' width='78'>Name:</td>"
strMsg = strMsg & "<td width='150'>"&REQUEST("CON_Ref_Name")&"</td>"
strMsg = strMsg & "<td width='50' rowspan='6'>&nbsp;</td>"
strMsg = strMsg & "<td width='78'>&nbsp;</td>"
strMsg = strMsg & "<td width='78'>&nbsp;</td>"
strMsg = strMsg & "<td rowspan='6' width='50'>&nbsp;</td>"
strMsg = strMsg & "<td width='70'>&nbsp;</td>"
strMsg = strMsg & "<td width='78'>&nbsp;</td>"
strMsg = strMsg & "<td width='50' rowspan='6'>&nbsp;</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr valign='top'>"
strMsg = strMsg & "<td class='main2'>Address:</td>"
strMsg = strMsg & "<td width='150'>"&REQUEST("CON_Main_Address1")&"</td><td>&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td> <td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr valign='top'>"
strMsg = strMsg & "<td class='main2'>Address 2:</td>"
strMsg = strMsg & "<td width='150'>"&REQUEST("CON_Main_Address2")&"</td>"
strMsg = strMsg & "<td>&nbsp;</td><td width='70'>&nbsp;</td><td width='70'>&nbsp;</td><td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr valign='top'>"
strMsg = strMsg & "<td class='main2'>City:</td>"
strMsg = strMsg & "<td width='150'>"&REQUEST("CON_Main_City")&"</td>"
strMsg = strMsg & "<td class='main2'>State:</td>"
strMsg = strMsg & "<td>"&REQUEST("CON_Main_State")&"</td>"
strMsg = strMsg & "<td class='main2' width='70'>Zip:</td>"
strMsg = strMsg & "<td>"&REQUEST("CON_Main_Zip")&"</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr valign='top'>"
strMsg = strMsg & "<td height='35' class='main2'>Home Phone:</td>"
strMsg = strMsg & "<td width='150'>"&REQUEST("CON_Main_Tel")&"</td>"
strMsg = strMsg & "<td class='main2' width='90'> Work Phone:</td>"
strMsg = strMsg & "<td>"&REQUEST("CON_Work_Phone")&"</td>"
strMsg = strMsg & "<td>&nbsp;</td>"
strMsg = strMsg & "<td>&nbsp;</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr valign='top'> "
strMsg = strMsg & "<td class='main2'>Date of Birth: </td>"
strMsg = strMsg & "<td width='150'><table width='100%' border='0' cellspacing='0' cellpadding='0'>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td width='30%'>"&REQUEST("CON_Birth_Date")&"/"&REQUEST("CON_Birth_Month")&"/"&REQUEST("CON_Birth_Year")&"</td>"
strMsg = strMsg & "</tr></table></td><td>&nbsp;</td><td>&nbsp;</td>"
strMsg = strMsg & "<td>&nbsp;</td><td>&nbsp;</td></tr> </table></tr>"
strMsg = strMsg & "<tr><td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr> <td class='main'>Drugs Taken:</td></tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td><table width='75%' border='0' cellspacing='0' cellpadding='0'>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td width='2%'><input type='checkbox' name='Pondimin'"
IF REQUEST("Pondimin") = "yes" tHEN
strMsg = strMsg & " Checked"
END IF
strMsg = strMsg & "></td>"
strMsg = strMsg & "<td class='main2' width='48%'><b>Pondimin (Fenfluramine)</b></td>"
strMsg = strMsg & "<td width='2%'><input type='checkbox' name='Redux' value='yes'"

IF REQUEST("Redux") = "yes" THEN

strMsg = strMsg & " Checked"
END IF
strMsg = strMsg & "></td>"
strMsg = strMsg & "<td class='main2' width='48%'><b>Redux (Dexfenfluramine)</b></td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "</table></td></tr>"
strMsg = strMsg & "<tr><td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr> <td><span class='main2'>From:</span>"&REQUEST("from")
strMsg = strMsg & "<span class='main2'> To:</span>"&REQUEST("to")
strMsg = strMsg & "<span style='font-family:Wingdings;'>"
strMsg = strMsg & "<input type='radio' name='less' value='0'"

IF REQUEST("less") = 0 THEN
strMsg = strMsg & " Checked"
END IF
strMsg = strMsg & "></span> <span class='main2'>60 days or less </span> <span style='font-family:Wingdings;'>"
strMsg = strMsg & "<input type='radio' name='less' value='1' "
IF REQUEST("less") = 1 THEN

strMsg = strMsg & " Checked"
END IF
strMsg = strMsg & "></span><span class='main2'>61 days or more</span></td></tr>"
strMsg = strMsg & "<tr><td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr> <td><span class='main2'>Prescribed by: </span>"&REQUEST("prescribed")
strMsg = strMsg & "<span class='main2'>Dispensed by:</span><u>"&REQUEST("dispenced")
strMsg = strMsg & "</u></td></tr>"
strMsg = strMsg & "<tr><td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr><td><u class='main'>Echocardiogram</u></td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr><td class='main2'>Please supply copies of all echocardiograms</td></tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr valign='top'>"
strMsg = strMsg & "<td><table width='75%' border='0' cellpadding='0' cellspacing='0' class='main2'>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td width='29%' class='main2'>Echo Date</td>"
strMsg = strMsg & "<td width='71%'><table width='35%' border='0' cellspacing='0' cellpadding='0'><tr>"
strMsg = strMsg & "<td width='30%'>"&REQUEST("Echo_Date")&"/"&REQUEST("Echo_Month")&"/"&REQUEST("Echo_Year")&"</td>"
strMsg = strMsg & "</tr></table></td></tr><tr> <td>&nbsp;</td><td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr><td>Cardiologist</td>"
strMsg = strMsg & "<td>"&REQUEST("Cardiologist")&"</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr> "
strMsg = strMsg & "<td>&nbsp;</td>"
strMsg = strMsg & "<td>&nbsp;</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr> "
strMsg = strMsg & "<td>Level</td>"
strMsg = strMsg & "<td>"&REQUEST("level")&"</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr><td>&nbsp;</td><td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td>Level of Mitrovalve Regurgitation (RJA/LAA)</td>"
strMsg = strMsg & "<td>"&REQUEST("Mitrovalve_Regurgitation")&"</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr><td>&nbsp;</td><td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr><td>Level of Aortic Regurgitation (RJH/VOT</td>"
strMsg = strMsg & "<td>"&REQUEST("Regurgitation") &"</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td>&nbsp;</td>"
strMsg = strMsg & "<td>&nbsp;</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr> "
strMsg = strMsg & "<td>Complications</td>"
strMsg = strMsg & "<td>"&REQUEST("Complications")&"</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "</table></td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr> "
strMsg = strMsg & "<td>&nbsp;</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr> "
strMsg = strMsg & "<td class='main2'><b>Were there any pre-existing conditions?</b></td></tr>"
strMsg = strMsg & "<tr valign='top'> "
strMsg = strMsg & "<td>"&REQUEST("conditions")&"</td></tr>"
strMsg = strMsg & "<tr><td>&nbsp;</td></tr><tr>"
strMsg = strMsg & "<td><u class='main'>Attorney</u></td></tr>"
strMsg = strMsg & "<tr><td><span class='main2'>Is this case taken on a contingency basis:</span><span class='main2'>Yes</span> <span class='main2'>"&REQUEST("contingency_yes")
strMsg = strMsg & "% &nbsp;</span><span class='main2'>No</span><span class='main2'>"&REQUEST("contingency_no")
strMsg = strMsg & "&nbsp;</span><b><u class='main2'>Costs to Date:<span class='main2'>"&REQUEST("costs")
strMsg = strMsg & "</span></u></b></td></tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td><span class='main2'>Case Preparation $<span class='main2'>"&REQUEST("case1")
strMsg = strMsg & "</span>Future $ "&REQUEST("future1")
strMsg = strMsg & "<u> </u></span><u></u></td></tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr><td><span class='main2'>Lost Client Income: $ "&REQUEST("lost")
strMsg = strMsg & "<u> </u> Future </span><span class='main2'> </span><span class='main2'>$ "&REQUEST("future2")
strMsg = strMsg & "<u> </u></span></td></tr>"
strMsg = strMsg & "<tr> <td>&nbsp;</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr> <td><span class='main2'>Medical $ "&REQUEST("medical")
strMsg = strMsg & "<u></u> Future $ "&REQUEST("future3")
strMsg = strMsg & "<u></u></span><u></u></td></tr>"
strMsg = strMsg & "<tr><td>&nbsp;</td></tr><tr> "
strMsg = strMsg & "<td><span class='main2'>Have any settlement offers (verbal / written) been made: $ "&REQUEST("money")
strMsg = strMsg & "</span><u> </u></td></tr>"
strMsg = strMsg & "<tr><td class='main2'>&nbsp;</td></tr>"
strMsg = strMsg & "<tr> "
strMsg = strMsg & "<td class='main2'>Will Clients Settlement Check Be Deposited Into Your Trust Account? <span style='font-family:Wingdings;'> <span style='font-family:Wingdings;'> <input type='radio' name='Settlement' value='Yes'"
IF REQUEST("Settlement") = "Yes" THEN
strMsg = strMsg & " Checked"
END IF
strMsg = strMsg & "></span></span> Yes <span style='font-family:Wingdings;'><input type='radio' name='Settlement' value='No'"

IF REQUEST("Settlement") = "No" THEN
strMsg = strMsg & " Checked"
END IF
strMsg = strMsg & " ></span> No</td></tr>"
strMsg = strMsg & "<tr><td>&nbsp;</td></tr>"
strMsg = strMsg & "<tr> <td><span class='main2'>What is <b><u>your estimated</u></b> Matrix Value of this case? </span><span class='main2'></span><span class='main2'>$ "&REQUEST("Matrix")
strMsg = strMsg & "</span><u></u></td></tr><tr><td class='main2'>&nbsp;</td></tr><tr> "
strMsg = strMsg & "<td class='main2'>What is<b><u> your estimated</u></b> Opt-Out Value of this case? $<span class='main2'>"&REQUEST("Opt-Out") &"</span></td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td>&nbsp;</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr><td><span class='main2'><b><i><u>Please note that this will not be revealed to anyone including your client and that we understand that you are offering no proffers of guaranty or opinion as it pertains to the viability of this case.</u></i></b></span><b><i><u></u></i></b></td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "<tr> <td>&nbsp;</td>"
strMsg = strMsg & "</tr><tr> <td class='main2'>Why Wouldn't This Case Settle?</td></tr><tr valign='top'><td>"&REQUEST("why")&"</td></tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td>Authorization:</td></tr>"
strMsg = strMsg & "<tr>"
strMsg = strMsg & "<td>"&REQUEST("Authorization")&"</td>"
strMsg = strMsg & "</tr>"
strMsg = strMsg & "</table></form>"

'response.write strMsg

strSubject = "Fen-Phen Application"
SET objMyCDONTSMail = CREATEOBJECT("CDONTS.NewMail")
objMyCDONTSMail.BodyFormat = 0
objMyCDONTSMail.MailFormat = 0
objMyCDONTSMail.Send "ap1@captran.com",strSubject,strMsg
SET objMyCDONTSMail = NOTHING


%>

miranda
08-03-2004, 04:40 PM
show us the page that has the form on it.

mckenzie
08-05-2004, 12:45 AM
The code is to long. I cant post it. Can I e-mail it to you?

miranda
08-05-2004, 02:20 AM
attach the file to a message here or point us to the url and we can view the source code

mckenzie
08-06-2004, 02:27 AM
Here is a link to the code for the form itself. Thanks in advance for all the help.... http://www.mckenziecreations.net/fenphen.htm



EZ Archive Ads Plugin for vBulletin Copyright 2006 Computer Help Forum