Name.
'; if(invalid_input($form_data[phone])) $alert .= 'Please enter a valid Phone.
'; if(invalid_email($form_data[email])) $alert .= 'Please enter a valid Email Address.
'; if(strtoupper($_POST['captcha']) != strtoupper($_SESSION['secCode'])) { $alert .= '

Letters from captcha have not been entered correctly.

'; } else { // security code is valid; reset it! $_SESSION['secCode'] = rand(100000, 999999); // echo "correct code"; } if(empty($alert)){ $message .= "---------------------------------------\n"; $message .= " Cataract Eye Surgery Contact Form Submission: $seq_number\n"; $message .= "---------------------------------------\n\n"; $message .= "\nName : ". $form_data[firstname]; $message .= "\nEmail: ". $form_data[email]; $message .= "\nAddress: ". $form_data[address]; $message .= "\nPostcode: ". $form_data[postcode]; $message .= "\nSuburb : ". $form_data[suburb]; $message .= "\nCity : ". $form_data[city]; $message .= "\nPhone : ". $form_data[phone]; $message .= "\nSend Brochure? : ". $form_data[brochure]; $message .= "\nComments: ". $form_data[comment]; $message .= "\n\n----------------END of MESSAGE-----------------------"; if(empty($form_data[email])) $form_data[email] = DEFAULT_EMAIL_ADDRESS; $seq_number = get_counter_value(); $message = preg_replace("/__SEQ_NUMBER__/", $seq_number, $message); // send email to mailing list admin mail(CONTACT_FORM_ADMIN_EMAIL, SITE_URL." Cataract Eye Surgery Booking Form - #".$seq_number, $message, "From: ".$form_data[email]); // save data $form_data[seq_number] = $seq_number; $form_data[comment] = preg_replace('/, $/', '', $form_data[comment]); $form_data[comment] = preg_replace("/\n/", ' ', $form_data[comment]); $form_data[comment] = preg_replace("/\r/", ' ', $form_data[comment]); save_data($form_data); $msg = '

Thank you for your booking. We will contact you shortly.

The reference number is: #'.$seq_number.'

'; unset($form_data); } } ?> Untitled Document
Cataract • lens extraction • lensectomy • customised lens implants • laser vision correction and enhancement • cataract surgery after laser vision correction • glaucoma and cataract • Parramatta
Thomson, Sumich, Lim and Associates
Hunter Street Eye Specialists
Parramatta, Sydney

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