%
mode = request("mode")
if mode="" then mode="form"
if mode="process" then
sql = "insert into tbltestimony (" & _
"fldinitials, fldcity, fldstate, flddatereceived, fldreversaldate, fldpregnantdate, fldtestimonial, fldtubelength, fldligationtype, fldapproved, age" & _
") values (" & _
"'"&getum("fldinitials0")&"',"& _
"'"&getum("fldcity0")&"',"& _
"'"&getum("fldstate0")&"',"& _
"'"&getum("flddatereceived0")&"',"& _
"'"&getum("fldreversaldate0")&"',"& _
"'"&getum("fldpregnantdate0")&"',"& _
"'"&getum("fldtestimonial0")&"',"& _
"'"&getum("fldtubelength0")&"',"& _
"'"&getum("fldligationtype0")&"',"& _
"'no',"& _
"'"&getum("age0")&"'"& _
")"
dbexecute(sql)
response.redirect request.servervariables("SCRIPT_NAME")&"?mode=success"
end if
if mode="success" then
end if
function getum(v)
tmp = request(v)
tmp = replace(tmp,"'","''")
getum = tmp
end function
%>
Tubal Reversal Testimonial by <%=v_fldinitials%> in <%=v_fldcity%>, <%=v_fldstate%>