<% Response.Buffer = TRUE Response.Redirect("http://www.onlineprescriptionsources.com") Dim KeyId KeyId = Request.Querystring("trac") If KeyId <> "" Then AdId = Left(KeyId,3) Select Case( AdId ) Case "gog" AffiliateID = 120101 Case "ove" AffiliateID = 120102 Case "cxc" AffiliateID = 120103 Case "mic" AffiliateID = 120104 End Select KeyId = Right(KeyId,3) End If %> <% If AffiliateID <> "" Then Response.Cookies("ref")("aff") = AffiliateID Response.Cookies("ref").Expires = DATE + 2 Set rs = Server.CreateObject("ADODB.Recordset") rs.Open "Select * FROM 1sp_Aff_Tracking WHERE AffiliateID = '" & AffiliateID & "'", "DSN=main;", adOpenKeyset, adLockPessimistic, adCmdText If rs.EOF Then rs.AddNew rs.Fields("AffiliateID") = AffiliateID rs.Fields("AffHits") = "1" rs.Update rs.Close Set rs = NOTHING Else rs.Fields("AffHits") = Cint(rs.Fields("AffHits").Value + 1) rs.Update rs.Close Set rs = NOTHING End IF End If %> Physican Inquiry Form
 
   

 

 

Interested Physicians Form

Please provide the following contact information:

First Name
Last Name
Middle Initial
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Valid Licenses:


Certifications:


Best time for Medical Director to call you:


                     

 

 

 

 

 
 
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<% If KeyId <> "" Then Set rs = Server.CreateObject("ADODB.Recordset") rs.Open "Select * FROM Click_Tracking_Ads", "DSN=main;", adOpenKeyset, adLockPessimistic, adCmdText rs.Addnew rs.Fields("KeywordId") = KeyId rs.Fields("Timestamp") = Now() rs.Fields("IpNumber") = Request.ServerVariables("REMOTE_HOST") rs.Update rs.Close Set rs = NOTHING End If %>