1-800-TECHLAB^® or by email at getlactoferrin@techlab.com.”;

if ($_POST[‘license’] === “no”) {
$errorMessage = “The FDA requires us to verify that your facility is licensed to perform moderate to high-complexity testing. Please call 1-800-TECHLAB^® to complete this step or provide a preferred time of day for us to call you to complete the verification and arrange delivery. Thank you for your interest in TECHLAB^® lactoferrin testing.”;
} else {
$errorMessage = “Thank you for your response. Please enter your contact information below and a TECHLAB^® team member will contact you shortly to qualify your request.”;
}
$errorForm = “

“;
}
}
?>

$v) {
$p[$k] = $con->real_escape_string($v);
$p[$k] = strip_tags($p[$k]);
}
$query = "INSERT INTO survey SET
title = '$p[title]',
first_name = '$p[first_name]',
last_name = '$p[last_name]',
company = '$p[company]',
street_address = '$p[address]',
city = '$p[city]',
state = '$p[state]',
zip = '$p[zip]',
phone = '$p[phone]',
email = '$p[email]',
currently_using = '$p[currently_using]',
test_type = '$p[test_type]',
utilization = '$p[utilization]',
likely_to_use = '$p[likely_to_use]',
unavailability_prohibiting_use = '$p[unavailability_prohibiting_use]',
further_investigation = '$p[further_investigation]',
kit_choice = '$p[kit]',
location = 1";
if (isset($p['preferredTOD'])) {
$query .= ", preferredTOD = '$p[preferredTOD]'";
}
$con->query($query);

//$to = "wallace@uncork-it.com";
$to = "getlactoferrin@techlab.com";
$subject = "Techlab Survey Submission";
$message = "A lactoferrin kit was requested by a potential customer" . ".\r\n\r\n";
$message .= "The information has been stored in the database, but here it is for your convenience:\r\n\r\n";
$message .= "Title: " . $p['title'] . "\r\n";
$message .= "First Name: " . $p['first_name'] . "\r\n";
$message .= "Last Name: " . $p['last_name'] . "\r\n";
$message .= "Company: " . $p['company'] . "\r\n";
$message .= "Address: " . $p['address'] . "\r\n";
$message .= "City: " . $p['city'] . "\r\n";
$message .= "State: " . $p['state'] . "\r\n";
$message .= "Zip: " . $p['zip'] . "\r\n";
$message .= "Phone: " . $p['phone'] . "\r\n";
if (isset($p['preferredTOD'])) {
$message .= "Preferred time to call: " . $p['preferredTOD'] . "\r\n";
}
$message .= "Email: " . $p['email'] . "\r\n";
$message .= "Currently using test? ";
if ($p['currently_using'] == "1") {
$message .= "Yes\r\n";
$message .= "Which test? " . $p['test_type'] . "\r\n";
$message .= "What utility? " . $p['utilization'] . "\r\n";
} else {
$message .= "No\r\n";
$message .= "How likely? " . $p['likely_to_use'] . "\r\n";
$message .= "Lack of availability? " . $p['unavailability_prohibiting_use'] . "\r\n";
}
$message .= "Needs further investigation? " . $p['further_investigation'] . "\r\n";
$message .= "Test type wanted: ";
if ($p['kit'] == "ezvue") {
$message .= "EZ VUE";
} elseif ($p['kit'] === "scan") {
$message .= "SCAN";
} elseif ($p['kit'] === "ibdCheck") {
$message .= "IBD-CHEK";
} elseif ($p['kit'] === "leuko") {
$message .= "LEUKO EZ VUE";
}
$from = "FROM: getlactoferrin@techlab.com";
mail($to, $subject, $message, $from);

$headers = 'MIME-Version: 1.0' . "\r\n";
$headers .= 'Content-type: text/html; charset=iso-8859-1' . "\r\n";
$headers .= "FROM: getlactoferrin@techlab.com";
$subject = "Thank You";
$message = "Thank you for your request, and interest in our lactoferrin portfolio of products." . "

";
if (isset($p['preferredTOD'])) {
$message .= "A representative will contact you shortly to follow up.

";
} else {
$message .= "A representative will contact you shortly to confirm shipping details.

";
}
$message .= "Thank you again, and please email us your questions at getlactoferrin@techlab.com

";
$message .= "";

mail($p['email'], $subject, $message, $headers);
?>

Get an evaluation test kit in just 3 easy steps* * Limit 1 test kit per facility. Redeeming facility must be licensed to perform moderate or high complexity testing. A confirmation of the facility’s testing license is required prior to shipment.

1. Choose your test kit

IBD-SCAN
An ELISA for the quantitative measurement of fecal lactoferrin

IBD EZ VUE
An immunochromatographic lateral flow test for the qualitative detection of elevated levels of fecal lactoferrin.

IBD-CHEK ®
An ELISA for the qualitative detection of elevated levels of lactoferrin, a marker for fecal leukocytes and an indicator of intestinal inflammation.

LEUKO EZ VUE ®
An immunochromatographic test for the qualitative detection of elevated levels of fecal lactoferrin, a marker for fecal leukocytes and an indicator of intestinal inflammation.

2. Tell us where to send your kit

Title:

First Name:

Last Name:

Company:

Street Address:

City:

State:

Zip:

Phone:

Preferred time of day for follow-up call:

Email:

3. Answer a few quick questions

$v) {
$p[$k] = htmlspecialchars($v);
}
?>