Order your contacts lenses

Contact lenses order
<% 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 %>


Please fill in all required fields below and we would be happy to refill your contact lenses.

Contact lens wearers require annual health and contact lens evaluations to maintain optimal comfort, vision and health.

<%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 & "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 & "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 = "lidkea2020@hotmail.com" Mailer.Cc = Request.Form("Courriel") Mailer.Subject = "Contact Lenses Order from Lidkea Optometry" 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 %>
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)
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 /> Refill my last order />
Comments:
Would you be interested in being kept informed of clinic promotions, offers or updates?
/> Yes /> No
 
<% end if %>