<%@LANGUAGE="VBSCRIPT" CODEPAGE="65001"%> <% Dim MM_editAction MM_editAction = CStr(Request.ServerVariables("SCRIPT_NAME")) If (Request.QueryString <> "") Then MM_editAction = MM_editAction & "?" & Server.HTMLEncode(Request.QueryString) End If ' boolean to abort record edit Dim MM_abortEdit MM_abortEdit = false %> <% ' IIf implementation Function MM_IIf(condition, ifTrue, ifFalse) If condition = "" Then MM_IIf = ifFalse Else MM_IIf = ifTrue End If End Function %> <% If (CStr(Request("MM_insert")) = "form1") Then If (Not MM_abortEdit) Then ' execute the insert Dim MM_editCmd Set MM_editCmd = Server.CreateObject ("ADODB.Command") MM_editCmd.ActiveConnection = MM_theretreat_STRING MM_editCmd.CommandText = "INSERT INTO dbo.consultation_cards (name, add1, add2, add3, add4, post_code, email, tel, dob, ailments, Current_medication, Recent_Operations, other_info, covid, cv_smell, cv_ppe, cv_travel, cv_high_risk, cv_mod_risk, consent_offers, consent_sms, consent, record_date) VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)" MM_editCmd.Prepared = true MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param1", 201, 1, 50, Request.Form("name")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param2", 201, 1, 50, Request.Form("add1")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param3", 201, 1, 50, Request.Form("add2")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param4", 201, 1, 50, Request.Form("add3")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param5", 201, 1, 50, Request.Form("add4")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param6", 201, 1, 50, Request.Form("post_code")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param7", 201, 1, 255, Request.Form("email")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param8", 201, 1, 50, Request.Form("tel_no")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param9", 202, 1, 10, Request.Form("dob")) ' adVarWChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param10", 201, 1, -1, Request.Form("ailments")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param11", 201, 1, -1, Request.Form("Current_medication")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param12", 201, 1, -1, Request.Form("Recent_Operations")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param13", 201, 1, -1, Request.Form("other_info")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param14", 201, 1, 255, Request.Form("covid")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param15", 201, 1, 255, Request.Form("cv_smell")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param16", 201, 1, 255, Request.Form("cv_ppe")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param17", 201, 1, 255, Request.Form("cv_travel")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param18", 201, 1, 255, Request.Form("cv_high_risk")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param19", 201, 1, 255, Request.Form("cv_mod_risk")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param20", 201, 1, 50, MM_IIF(Request.Form("consent_offers"), "Y", "N")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param21", 201, 1, 50, MM_IIF(Request.Form("consent_sms"), "Y", "N")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param22", 201, 1, 50, MM_IIF(Request.Form("consent"), "Y", "N")) ' adLongVarChar MM_editCmd.Parameters.Append MM_editCmd.CreateParameter("param23", 202, 1, 10, Request.Form("record_date")) ' adVarWChar MM_editCmd.Execute MM_editCmd.ActiveConnection.Close End If End If %> <% Dim Recordset1__mmid Recordset1__mmid = "0" If (request.querystring("section") <> "") Then Recordset1__mmid = request.querystring("section") End If %> <% Dim Recordset1 Dim Recordset1_cmd Dim Recordset1_numRows Set Recordset1_cmd = Server.CreateObject ("ADODB.Command") Recordset1_cmd.ActiveConnection = MM_theretreat_STRING Recordset1_cmd.CommandText = "SELECT * FROM treatments WHERE Expr7=? ORDER BY ID, running_odr, sub_s_ID, running_order" Recordset1_cmd.Prepared = true Recordset1_cmd.Parameters.Append Recordset1_cmd.CreateParameter("param1", 200, 1, 255, Recordset1__mmid) ' adVarChar Set Recordset1 = Recordset1_cmd.Execute Recordset1_numRows = 0 %> <% Dim Recordset2 Dim Recordset2_cmd Dim Recordset2_numRows Set Recordset2_cmd = Server.CreateObject ("ADODB.Command") Recordset2_cmd.ActiveConnection = MM_theretreat_STRING Recordset2_cmd.CommandText = "SELECT * FROM dbo.ailments" Recordset2_cmd.Prepared = true Set Recordset2 = Recordset2_cmd.Execute Recordset2_numRows = 0 %> <% Dim Repeat1__numRows Dim Repeat1__index Repeat1__numRows = -1 Repeat1__index = 0 Recordset2_numRows = Recordset2_numRows + Repeat1__numRows %> The Cambourne Retreat

Consultation Information

So that we can provide your treatment in the safest way possible we require you to provide the information requested below. This information is only used in relation to your requested treatment.

<% If Request.Form("name")="" Then %>
Name Address Post Code
email Tel Date Of Birth

Current Medical Conditions <% While ((Repeat1__numRows <> 0) AND (NOT Recordset2.EOF)) %> <% Repeat1__index=Repeat1__index+1 Repeat1__numRows=Repeat1__numRows-1 Recordset2.MoveNext() Wend %>
" id="ailments" style="-webkit-appearance:checkbox !important; opacity: 1;float: none;margin-right:5px;"> <%=(Recordset2.Fields.Item("name").Value)%>

Current medication Recent Operations Any other information that may help us?

Covid-19

Have you or anyone in your household had COVID-19? Have you or anyone is your household had any of the following symptoms in the last 14 days: dry cough, fever, high temperature, shortness of breath, loss of sense of taste or smell? Have you been in close contact with anyone with confirmed Covid-19 without wearing appropriate PPE? Have you travelled outside the UK in the last 14 days? Are you in the high risk category (clinically extremely vulnerable) as defined by the UK government? Are you in the moderate risk category (clinically vulnerable) as defined by the UK government?

Appointment Guidance

Please only attend at your appointment time.
Please ensure you are on time- if you are late it may result in your appointment being cancelled.  
Please limit personal possessions you bring with you (leave securely in your car where possible).
Please wear a mask to your appointment, they are also available to purchase from reception.
Upon arrival you must wash your hands and use the hand sanitiser provided.
Contactless payment only unless you have made payment prior to your appointment.
If you experience COVID-19 symptoms after your appointment, please contact us immediately.
May we use your email address to send you marketing offers?
May we send marketing offers via SMS?
I agree for The Retreat Barhill to use this information in relation to my treatment.
<% Else %>

Thank You for Completing Yor consultation form

<% End If %>

The information you have entered will be used only for the suitability of our treatments and will never be shared with other parties. If you have any other questions or wish to make a booking email info@theretreatbarhill.com or call 01954 249986

<% Recordset1.Close() Set Recordset1 = Nothing %> <% Recordset2.Close() Set Recordset2 = Nothing %>