<% if(request.form("submit")="Send") then full_Name = request.form("full_Name") Street_Address = request.form("Street_Address") City = request.form("City") State = request.form("State") country = request.form("country") Pin_Code= request.form("Pin_Code") Tel = request.form("Tel") Fax = request.form("Fax") Email = request.form("Email") Feedback = request.form("Feedback") msg_body = "User's Feedback

" msg_body = msg_body&"Full Name : "&full_Name&"
" msg_body = msg_body&"Address : "&Street_Address&"
" msg_body = msg_body&"City : "&City&"
" msg_body = msg_body&"State : "&State&"
" msg_body = msg_body&"Country : "&country&"
" msg_body = msg_body&"Pin_Code : "&Pin_Code&"
" msg_body = msg_body&"Phone : "&Tel&"
" msg_body = msg_body&"Fax : "&Fax&"
" msg_body = msg_body&"E-Mail : "&Email&"
" msg_body = msg_body&"Feedback : "&Feedback&"
" ' *************Email Code********************** Dim MyMail Set MyMail = Server.CreateObject("CDONTS.NewMail") MyMail.From = Email MyMail.To = "info@rocklandhospital.com" 'MyMail.To = "lkgahlot@netcommlabs.com" MyMail.Subject = "Rocklandhospital.com - Feedback" MyMail.BodyFormat=0 MyMail.MailFormat=0 MyMail.Body = msg_body MyMail.Send Set MyMail = Nothing '***************************************************************** response.redirect "confirmation.htm" end if %> Rockland Hospital - Feedback
HealthCare Services
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  Newsletter_Artwork_-_Rockland.pdf
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