<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> <% function MyCaptcha(byval valSession, byval valCaptcha) dim tmpSession valSession = Trim(valSession) valCaptcha = Trim(valCaptcha) if (valSession = vbNullString) or (valCaptcha = vbNullString) then MyCaptcha = false else tmpSession = valSession valSession = Trim(Session(valSession)) Session(tmpSession) = vbNullString if valSession = vbNullString then MyCaptcha = false else valCaptcha = Replace(valCaptcha,"i","I") if StrComp(valSession,valCaptcha,1) = 0 then MyCaptcha = true else MyCaptcha = false end if end if end if end function %> Wedding Cosmetic Dentist - Request An Appointment <% if not IsEmpty(Request.Form("btnSubmit")) then ' Form has been submitted so set some session variables to pass over to the email form if successful ' or populate the input boxes on the form if it is not successful. Session("PrefixName") = Request.Form("txtPrefixName") Session("FirstName") = Request.Form("txtFirstName") Session("LastName") = Request.Form("txtLastName") Session("Telephone") = Request.Form("txtTelephone") Session("EmailAddress") = Request.Form("txtEmailAddress") ' Now test the captcha code entered byt he user. if MyCaptcha("INPUTFORMCAPTCHA", Request.Form("txtCaptchaCode")) then Response.Redirect("send_appointment.asp") else ' Set a variable so we can put the focus back into the Cpatcha input box on the form. Dim WrongCodeEntered WrongCodeEntered = 1 end if end if %>

Request An Appointment

If you would like to request an appointment, why not fill in the form below and we'll call you back and arrange an appointment at a time that's convenient for you.

Your details will not be passed on to any 3rd party and you will not receive any marketing material.


"" then Response.Write(Session("FirstName")) %>" />
"" then Response.Write(Session("LastName")) %>" />
"" then Response.Write(Session("Telephone")) %>" />
"" then Response.Write(Session("EmailAddress")) %>" />
Confirmation Code Image


<% if WrongCodeEntered = 1 then %> <% end if %>