Complex Form ASP Submission

**schofio** · 02-06-2010, 09:47 PM

Hi,

I'm looking to submit a complex form, found here:

http://thedentalimplantclinic.com/referral.htm

Currently I use FrontPage Server Extensions and thus have a Webbot submitting the form, but I want to switch to FTP and therefore need an easy way to submit this form to an email in a readable fashion. However, my webhost is 1&1 microsoft hosting, so the only scripting I can use is ASP. I have used an ASP script to submit a simple online enquiry form, found here but is there an easy way I can use it to submit the referral form?

Alternatively, is there a free hosted solution or form builder I should be aware of?

Thanks in advance for your help,
Oli

**schofio** · 02-10-2010, 05:55 PM

This is the code I am trying:

Code:

<% @LANGUAGE="VBSCRIPT" CODEPAGE="1252"%>
<html>
<head>
<title></title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
</head> 
<body>
<% 
Set Mail = Server.CreateObject("SMTPsvg.Mailer") 'create an Asp mail component.
Mail.FromName   = Request.Form("DentistName")
Mail.FromAddress= Request.Form("DentistEmail")
Mail.RemoteHost = "mrelay.perfora.net" ' The mail server you have to use with Asp Mail
Mail.AddRecipient "Redacted" , "Redacted"
Mail.Subject    = "Online Referral"
Mail.BodyText   = "Practitioner -"
Mail.BodyText   = " "
Mail.BodyText   = "Name:"
Mail.BodyText   = Request.Form("DentistName")
Mail.BodyText   = " "
Mail.BodyText   = "Email Address:"
Mail.BodyText   = Request.Form("DentistEmail")
Mail.BodyText   = " "
Mail.BodyText   = "Address:"
Mail.BodyText   = Request.Form("DentistStreetAddress")
Mail.BodyText   = " "
Mail.BodyText   = "Telephone:"
Mail.BodyText   = Request.Form("DentistTelNo")
Mail.BodyText   = " "
Mail.BodyText   = "Patient -"
Mail.BodyText   = " "
Mail.BodyText   = "Name:"
Mail.BodyText   = Request.Form("PatientName")
Mail.BodyText   = " "
Mail.BodyText   = "Email Address:"
Mail.BodyText   = Request.Form("PatientEmail")
Mail.BodyText   = " "
Mail.BodyText   = "Address:"
Mail.BodyText   = Request.Form("PatientStreetAddress")
Mail.BodyText   = " "
Mail.BodyText   = "Telephone:"
Mail.BodyText   = Request.Form("PatientTelNo")
Mail.BodyText   = " "
Mail.BodyText   = "Implants:"
If Request.Form("Implant_18") <> "" Then Mail.BodyText = "18"
If Request.Form("Implant_17") <> "" Then Mail.BodyText = "17"
If Request.Form("Implant_16") <> "" Then Mail.BodyText = "16"
If Request.Form("Implant_15") <> "" Then Mail.BodyText = "15"
If Request.Form("Implant_14") <> "" Then Mail.BodyText = "14"
If Request.Form("Implant_13") <> "" Then Mail.BodyText = "13"
If Request.Form("Implant_12") <> "" Then Mail.BodyText = "12"
If Request.Form("Implant_11") <> "" Then Mail.BodyText = "11"
If Request.Form("Implant_28") <> "" Then Mail.BodyText = "28"
If Request.Form("Implant_27") <> "" Then Mail.BodyText = "27"
If Request.Form("Implant_26") <> "" Then Mail.BodyText = "26"
If Request.Form("Implant_25") <> "" Then Mail.BodyText = "25"
If Request.Form("Implant_24") <> "" Then Mail.BodyText = "24"
If Request.Form("Implant_23") <> "" Then Mail.BodyText = "23"
If Request.Form("Implant_22") <> "" Then Mail.BodyText = "22"
If Request.Form("Implant_21") <> "" Then Mail.BodyText = "21"
If Request.Form("Implant_38") <> "" Then Mail.BodyText = "38"
If Request.Form("Implant_37") <> "" Then Mail.BodyText = "37"
If Request.Form("Implant_36") <> "" Then Mail.BodyText = "36"
If Request.Form("Implant_35") <> "" Then Mail.BodyText = "35"
If Request.Form("Implant_34") <> "" Then Mail.BodyText = "34"
If Request.Form("Implant_33") <> "" Then Mail.BodyText = "33"
If Request.Form("Implant_32") <> "" Then Mail.BodyText = "32"
If Request.Form("Implant_31") <> "" Then Mail.BodyText = "31"
If Request.Form("Implant_48") <> "" Then Mail.BodyText = "48"
If Request.Form("Implant_47") <> "" Then Mail.BodyText = "47"
If Request.Form("Implant_46") <> "" Then Mail.BodyText = "46"
If Request.Form("Implant_45") <> "" Then Mail.BodyText = "45"
If Request.Form("Implant_44") <> "" Then Mail.BodyText = "44"
If Request.Form("Implant_43") <> "" Then Mail.BodyText = "43"
If Request.Form("Implant_42") <> "" Then Mail.BodyText = "42"
If Request.Form("Implant_41") <> "" Then Mail.BodyText = "41"
Mail.BodyText   = " "
Mail.BodyText   = "Extractions:"
If Request.Form("Extraction_18") <> "" Then Mail.BodyText = "18"
If Request.Form("Extraction_17") <> "" Then Mail.BodyText = "17"
If Request.Form("Extraction_16") <> "" Then Mail.BodyText = "16"
If Request.Form("Extraction_15") <> "" Then Mail.BodyText = "15"
If Request.Form("Extraction_14") <> "" Then Mail.BodyText = "14"
If Request.Form("Extraction_13") <> "" Then Mail.BodyText = "13"
If Request.Form("Extraction_12") <> "" Then Mail.BodyText = "12"
If Request.Form("Extraction_11") <> "" Then Mail.BodyText = "11"
If Request.Form("Extraction_28") <> "" Then Mail.BodyText = "28"
If Request.Form("Extraction_27") <> "" Then Mail.BodyText = "27"
If Request.Form("Extraction_26") <> "" Then Mail.BodyText = "26"
If Request.Form("Extraction_25") <> "" Then Mail.BodyText = "25"
If Request.Form("Extraction_24") <> "" Then Mail.BodyText = "24"
If Request.Form("Extraction_23") <> "" Then Mail.BodyText = "23"
If Request.Form("Extraction_22") <> "" Then Mail.BodyText = "22"
If Request.Form("Extraction_21") <> "" Then Mail.BodyText = "21"
If Request.Form("Extraction_38") <> "" Then Mail.BodyText = "38"
If Request.Form("Extraction_37") <> "" Then Mail.BodyText = "37"
If Request.Form("Extraction_36") <> "" Then Mail.BodyText = "36"
If Request.Form("Extraction_35") <> "" Then Mail.BodyText = "35"
If Request.Form("Extraction_34") <> "" Then Mail.BodyText = "34"
If Request.Form("Extraction_33") <> "" Then Mail.BodyText = "33"
If Request.Form("Extraction_32") <> "" Then Mail.BodyText = "32"
If Request.Form("Extraction_31") <> "" Then Mail.BodyText = "31"
If Request.Form("Extraction_48") <> "" Then Mail.BodyText = "48"
If Request.Form("Extraction_47") <> "" Then Mail.BodyText = "47"
If Request.Form("Extraction_46") <> "" Then Mail.BodyText = "46"
If Request.Form("Extraction_45") <> "" Then Mail.BodyText = "45"
If Request.Form("Extraction_44") <> "" Then Mail.BodyText = "44"
If Request.Form("Extraction_43") <> "" Then Mail.BodyText = "43"
If Request.Form("Extraction_42") <> "" Then Mail.BodyText = "42"
If Request.Form("Extraction_41") <> "" Then Mail.BodyText = "41"
Mail.BodyText   = " "
Mail.BodyText   = "Endodontics:"
If Request.Form("Endo_18") <> "" Then Mail.BodyText = "18"
If Request.Form("Endo_17") <> "" Then Mail.BodyText = "17"
If Request.Form("Endo_16") <> "" Then Mail.BodyText = "16"
If Request.Form("Endo_15") <> "" Then Mail.BodyText = "15"
If Request.Form("Endo_14") <> "" Then Mail.BodyText = "14"
If Request.Form("Endo_13") <> "" Then Mail.BodyText = "13"
If Request.Form("Endo_12") <> "" Then Mail.BodyText = "12"
If Request.Form("Endo_11") <> "" Then Mail.BodyText = "11"
If Request.Form("Endo_28") <> "" Then Mail.BodyText = "28"
If Request.Form("Endo_27") <> "" Then Mail.BodyText = "27"
If Request.Form("Endo_26") <> "" Then Mail.BodyText = "26"
If Request.Form("Endo_25") <> "" Then Mail.BodyText = "25"
If Request.Form("Endo_24") <> "" Then Mail.BodyText = "24"
If Request.Form("Endo_23") <> "" Then Mail.BodyText = "23"
If Request.Form("Endo_22") <> "" Then Mail.BodyText = "22"
If Request.Form("Endo_21") <> "" Then Mail.BodyText = "21"
If Request.Form("Endo_38") <> "" Then Mail.BodyText = "38"
If Request.Form("Endo_37") <> "" Then Mail.BodyText = "37"
If Request.Form("Endo_36") <> "" Then Mail.BodyText = "36"
If Request.Form("Endo_35") <> "" Then Mail.BodyText = "35"
If Request.Form("Endo_34") <> "" Then Mail.BodyText = "34"
If Request.Form("Endo_33") <> "" Then Mail.BodyText = "33"
If Request.Form("Endo_32") <> "" Then Mail.BodyText = "32"
If Request.Form("Endo_31") <> "" Then Mail.BodyText = "31"
If Request.Form("Endo_48") <> "" Then Mail.BodyText = "48"
If Request.Form("Endo_47") <> "" Then Mail.BodyText = "47"
If Request.Form("Endo_46") <> "" Then Mail.BodyText = "46"
If Request.Form("Endo_45") <> "" Then Mail.BodyText = "45"
If Request.Form("Endo_44") <> "" Then Mail.BodyText = "44"
If Request.Form("Endo_43") <> "" Then Mail.BodyText = "43"
If Request.Form("Endo_42") <> "" Then Mail.BodyText = "42"
If Request.Form("Endo_41") <> "" Then Mail.BodyText = "41"
Mail.BodyText   = " "
Mail.BodyText   = "Periodontal Disease:"
If Request.Form("PerioLocalised") <> "" Then Mail.BodyText = "PerioLocalised"
If Request.Form("PerioGeneralised") <> "" Then Mail.BodyText = "PerioGeneralised"
If Request.Form("PerioRegeneration") <> "" Then Mail.BodyText = "PerioRegeneration"
If Request.Form("PeriImplantitis") <> "" Then Mail.BodyText = "PeriImplantitis"
If Request.Form("PeriGingivalRegression") <> "" Then Mail.BodyText = "PerioGingivalRegression"
If Request.Form("PerioCrownLengthening") <> "" Then Mail.BodyText = "PerioCrownLengthening"
If Request.Form("PerioGummySmile") <> "" Then Mail.BodyText = "PerioGummySmile"
If Request.Form("PerioOther") <> "" Then Mail.BodyText = Request.Form("PerioOtherDetails")
Mail.BodyText   = " "
Mail.BodyText   = Request.Form("Other")

if Mail.SendMail then
 Response.Redirect("thankyou.htm")
else
 Response.Redirect("failed.htm")
end if 
%> 
</html>

This is the important part of the other, working, code:

Code:

<% 
Set Mail = Server.CreateObject("SMTPsvg.Mailer") 'create an Asp mail component.
Mail.FromName   = Request.Form("name")
Mail.FromAddress= Request.Form("email")
Mail.RemoteHost = "mrelay.perfora.net" ' The mail server you have to use with Asp Mail
Mail.AddRecipient "Redacted" , "Redacted"
Mail.Subject    = "Online Enquiry"
Mail.BodyText   = "Name:"
Mail.BodyText   = Request.Form("name")
Mail.BodyText   = " "
Mail.BodyText   = "Email Address:"
Mail.BodyText   = Request.Form("email")
Mail.BodyText   = " "
Mail.BodyText   = "Address:"
Mail.BodyText   = Request.Form("address")
Mail.BodyText   = " "
Mail.BodyText   = "He/She is a:"
If Request.Form("patient") <> "" Then Mail.BodyText = "Patient"
If Request.Form("prospatient") <> "" Then Mail.BodyText = "Prospective patient"
If Request.Form("dentist") <> "" Then Mail.BodyText = "Dentist"
If Request.Form("other") <> "" Then Mail.BodyText = Request.Form("otherspec")
Mail.BodyText   = " "
Mail.BodyText   = "He/She Found out about us from:"
Mail.BodyText   = Request.Form("hearabout")
Mail.BodyText   = " "
Mail.BodyText   = "Enquiry:"
Mail.BodyText   = Request.Form("enquiry")

if Mail.SendMail then
 Response.Redirect("thankyou.htm")
else
 Response.Redirect("failed.htm")
end if 
%>

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