his script was created by DBTECHNOSYSTEMS.com ----
// © DBTechnosystems.com http://www.dbtechnosystems.com
// You may use this script but please leave author details here
// DBTS Form Processor Extension version 2.7.5.6
ini_set('display_errors', 1);
$version = "2.7.5.6";
error_reporting(0);
if(session_id() == ""){
session_start();
}
if("Working Mode" == "Debug Mode"){
error_reporting(E_ALL);
}
$SESSION = $_SESSION['POST'];
if(is_array($SESSION)){
while (list ($key, $val) = each($SESSION)) {
// Stripslashes only if it is not an array, or it empties the array
if (!is_array($val)) {
$SESSION[$key] = stripslashes($val);
}
}
extract ($SESSION, EXTR_OVERWRITE);
}
if($_SERVER['REQUEST_METHOD'] == 'POST')
{
$error="";
require_once 'dbts_includes/dbts_functions.php';
// -------- RECEIVIMG CONFIG FILE VARIABLES-----------
$form_id = "1";
$from_email = "info@drclivenovis.co.za";
$nameto = "Webmaster";
$mailto = "jaco@striatum.co.za, annatjie@drclivenovis.co.za";
$cc_email = "clivenovis@mweb.co.za";
$bcc_email = "";
$email_field = "Email";
$charset = "ISO-8859-1";
$success_url = " ";
$error_url = "index.php";
$timezone = "Africa/Johannesburg";
if(trim($timezone) != ""){
if (function_exists(date_default_timezone_set)) {
date_default_timezone_set($timezone);
}
else{
putenv ($timezone);
mktime(0,0,0,1,1,1970);
}
}
$time_format = "";
$date = date("l jS F Y, g:i A");
if(trim($time_format) != ""){
$date = date("");
}
$admin_mail = "Yes";
$autoresponder = "Yes";
$csvStore = "No";
$dbStore = "No";
$post_further = "No";
$post_further_to = "";
$copy_in_session = "No";
$copy_from_session = "No";
$clear_session = "No";
$afterprocessing = "Exit";
$end_include = "";
$include_null_fields = "Yes";
$null_field_text = "No user input";
$excluded_fields = "";
$allow_urls = "Yes";
$captcha_rewrite = "Yes";
$captcha_error = "The entered code is wrong!";
$force_recaptcha = "No";
$privatekey = "";
$recaptcha_error_array['invalid-site-private-key'] = "We weren't able to verify the private key.";
$recaptcha_error_array['invalid-request-cookie'] = "The challenge parameter of the verify script was incorrect.";
$recaptcha_error_array['incorrect-captcha-sol'] = "The code you have entered in the captcha is wrong";
$recaptcha_error_array['recaptcha-not-reachable'] = "The captcha verification server is not accessible at the moment, so we can't verify your input. Please try again later.";
$recaptcha_failure_behavior = "Allow submission";
$use_reverse_captcha = "No";
$non_empty_field_name = "";
$non_empty_field_value = "";
$empty_field_name = "";
$reverse_captcha_error = "";
$reverse_captcha_behavior = "Display Success Page";
$enable_departments = "No";
$department_field = "department";
$departments = array();
$department_emails = array();

$banned_behavior = "Display Success Page";
$banned_error = "";
$banned_ipname = array();
$banned_ipaddress = array();
$banned_ipname[] = "Unknown";
$banned_ipaddress[] = "31.204.181.000 - 31.204.181.254";
$banned_ipname[] = "unknown";
$banned_ipaddress[] = "5.188.211.000 - 5.188.211.254";

$bannedemail_names = array();
$bannedemail_emails = array();

$logo_image_url = "images/mail_logo.jpg";
$logo_alt = "Visit Dr Clive Novis !";
$logo_link = "http://www.drclivenovis.co.za";
$logo_bgrd_clr = "#FFFFFF";
$logo_align = "left";
$table_width = "600";
$labelscolumn_width = "";
$cellspacing = "2";
$cellpadding = "2";
$border_width = "0";
$border_clr = "#000000";
$border_type = strtolower("Default");
$bgrd_clr = "#FFFFFF";
$table_bgrd_clr = "#FFFFFF";
$header_bgrd_clr = "#FFFFFF";
$footer_bgrd_clr = "#FFFFFF";
$labels_text_clr = "#000000";
$labels_bkgd_clr = "#FFFFFF";
$values_text_clr = "#000000";
$values_bkgd_clr = "#FFFFFF";
$time_of_submission_label = "Time of Submission";
$ip_address_label = "IP Address";
$browser_label = "Browser";
$admin_mode = "HTML";
$subject = "New Submission from our Website Form";
$namefrom = "Website Form Manager";
$form_namefrom = "";
$htmlbodystart = 'There has been a new submission from our Website form. Here is the info submitted:';
$bodystart = "There has been a new submission from our Website form. Here is the info submitted:";
$htmlbodyend = 'Please review and act accordingly.';
$bodyend = "Please review and act accordingly.";
$custom_admin_mail_template = "";
$include_ip ="Yes";
$include_browser = "Yes";
$include_datetime = "Yes";
$auto_mode = "HTML";
$autorespondersubject = "Contact Confirmation";
$autoresponderfrom = "info@drclivenovis.co.za";
$include_info = "Yes";
$autorespondernamefrom = "Dr Clive Novis";
$auto_form_nameto = "";
$htmlautoresponderstart= 'Hello, this email is to confirm that your info has been received.';
$autoresponderstart = "Hello, this email is to confirm that your info has been received.";
$htmlautoresponderend = 'Thank you for contacting us!';
$autoresponderend = "Thank you for contacting us!";
$custom_auto_mail_template = "";
$auto_include_datetime = "Yes";
$auto_attach = "";
$file_ext = strtolower("jpg, gif, png, bmp, mp3, pdf, html, htm");
$filesize = "1024";
$store_uploaded = "Yes";
$uploadfolder = "uploads";
$add_prefix = "Yes";
$attach_files = "No";
$max_attach_size = "10";
$double_quote_fields = "Yes";
$csvSeparator = "comma ,";
$csvFile = "fomdata.csv";
$db_host      = "localhost";
$db_name      = "database_name";
$db_user      = "username";
$db_password  = "password";
$db_table     = "table_name";
$create_table = "Yes";
$add_columns  = "Yes";
$mail_engine    = "mail() function";
$SMTPSecure = "No";
$SMTPHost   = "";
$SMTPPort   = "25";
$SMTPAuth   = "false";
$SMTPUser   = "you@smtp.com";
$SMTPPass   = "";
$start_of_script_include = '';
$before_formdata_include = '';
$after_formdata_include = '';
$after_filedata_include = '';
$before_error_include = '';
$before_admin_mail_include = '';
$before_auto_mail_include = '';
$end_of_script_include = '';
$end_include = '';
//  End of settings section
//  Process form
include 'dbts_includes/dbts_formprocessor.php';
}
?>
<!doctype html>
<html lang="en-za">
<head>
<meta charset="iso-8859-1">
<title>Contact Dr Clive Novis</title>
<meta name="author" content="Solis Marketing and Technology">
<meta name="generator" content="WYSIWYG Web Builder 16 - http://www.wysiwygwebbuilder.com">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<link href="favicon.ico" rel="shortcut icon" type="image/x-icon">
<link href="https://fonts.googleapis.com/css?family=Candara&display=swap" rel="stylesheet">
<link href="https://fonts.googleapis.com/css?family=Cantarell&display=swap" rel="stylesheet">
<link href="https://fonts.googleapis.com/css?family=Candara&display=swap" rel="stylesheet">
<link href="https://fonts.googleapis.com/css?family=Cantarell&display=swap" rel="stylesheet">
<link href="contact-us.css" rel="stylesheet">
<script>   
   function submitContact_Form()
   {
      var regexp;
      var Combobox1 = document.getElementById('Combobox1');
      if (!(Combobox1.disabled ||
            Combobox1.style.display === 'none' ||
            Combobox1.style.visibility === 'hidden'))
      {
         if (Combobox1.selectedIndex == 0)
         {
            alert("The first \"Query Type\" option is not a valid selection.  Please choose one of the other options.");
            Combobox1.focus();
            return false;
         }
      }
      return true;
   }
</script>
<meta name="form_processor" content="DBTS WWB Form Processor v. 2.7.5.7">
<!-- Google Analystics code -->
<script>   
     (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
     (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
     m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
     })(window,document,'script','//www.google-analytics.com/analytics.js','ga');
   
     ga('create', 'UA-63919791-1', 'auto');
     ga('send', 'pageview');
   
</script>
</head>
<body>
   <div id="container">
   </div>
   <div id="Layer3" style="position:absolute;text-align:center;left:1px;top:99px;width:100%;height:1101px;z-index:70;">
      <div id="Layer3_Container" style="width:994px;position:relative;margin-left:auto;margin-right:auto;text-align:left;">
         <div id="wb_Text1" style="position:absolute;left:10px;top:15px;width:180px;height:29px;z-index:11;">
            <span style="color:#606060;font-family:Candara;font-size:24px;"><strong><u>Find Direction</u></strong></span><span style="color:#606060;font-family:Cantarell;font-size:24px;"><u> </u></span></div>
         <div id="wb_Text2" style="position:absolute;left:664px;top:74px;width:198px;height:23px;z-index:12;">
            <span style="color:#606060;font-family:Candara;font-size:19px;"><strong>Optiklin Eye Hospital</strong></span></div>
         <div id="wb_Text3" style="position:absolute;left:664px;top:105px;width:306px;height:20px;z-index:13;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">104 Klein street, Benoni</span></div>
<!-- Google Map Benoni -->
         <div id="Html1" style="position:absolute;left:10px;top:194px;width:320px;height:240px;z-index:14">
            <iframe src="https://www.google.com/maps/embed?pb=!1m18!1m12!1m3!1d3579.955064228098!2d28.291890000000002!3d-26.198140000000002!2m3!1f0!2f0!3f0!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x1e9517d0e8918659%3A0xe035e6c97a819bbe!2s23+Sunnyside+Ave%2C+Benoni%2C+1501!5e0!3m2!1sen!2sza!4v1433408505976" width="320" height="240" frameborder="0" style="border:0"></iframe></div>
<!-- Google Map Springs -->
         <div id="Html2" style="position:absolute;left:337px;top:194px;width:320px;height:240px;z-index:15">
            <iframe src="https://www.google.com/maps/embed?pb=!1m18!1m12!1m3!1d3577.877773999678!2d28.436449999999997!3d-26.265629999999998!2m3!1f0!2f0!3f0!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x1e95244a6371a5f1%3A0xe1dc214a36be5408!2s10+Gillespie+Rd%2C+Springs%2C+1559!5e0!3m2!1sen!2sza!4v1433408714155" width="320" height="240" frameborder="0" style="border:0"></iframe></div>
<!-- Google Map OpriKlin -->
         <div id="Html3" style="position:absolute;left:664px;top:194px;width:320px;height:240px;z-index:16">
            <iframe src="https://www.google.com/maps/embed?pb=!1m18!1m12!1m3!1d3580.5765424638726!2d28.286693300000003!3d-26.177917100000002!2m3!1f0!2f0!3f0!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x1e95163ac68c03e5%3A0xed471cfda0d54031!2s104+Klein+St%2C+Benoni%2C+1501!5e0!3m2!1sen!2sza!4v1433409011715" width="320" height="240" frameborder="0" style="border:0"></iframe></div>
         <div id="wb_Text8" style="position:absolute;left:10px;top:691px;width:789px;height:23px;z-index:17;">
            <span style="color:#606060;font-family:Candara;font-size:19px;">Please complete the form and we will get back to you and schedule an appointment if required.</span></div>
         <div id="wb_Text9" style="position:absolute;left:337px;top:136px;width:276px;height:20px;z-index:18;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">Tel: (011) 815-1117 </span></div>
         <div id="wb_Text11" style="position:absolute;left:664px;top:136px;width:250px;height:20px;z-index:19;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">Tel: (011) 306-1620</span></div>
         <div id="wb_Text5" style="position:absolute;left:10px;top:105px;width:285px;height:20px;z-index:20;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">23 Sunnyside Ave, Westdene, Benoni</span></div>
         <div id="wb_Text12" style="position:absolute;left:10px;top:657px;width:250px;height:26px;z-index:21;">
            <span style="color:#606060;font-family:Candara;font-size:21px;"><strong><u>Contact Dr. Novis's Rooms</u></strong></span></div>
         <div id="wb_Form1" style="position:absolute;left:10px;top:714px;width:974px;height:370px;z-index:22;">
            <form name="Contact_Form" method="post" action="contact-us.php" enctype="multipart/form-data" id="Form1" onsubmit="return submitContact_Form()">
               <input type="hidden" name="formid" value="1">
               <input type="text" id="Editbox1" style="position:absolute;left:9px;top:18px;width:294px;height:25px;z-index:0;" name="First Name" value="" spellcheck="false" placeholder="First Name (*)">
               <input type="text" id="Editbox2" style="position:absolute;left:335px;top:18px;width:294px;height:25px;z-index:1;" name="Surname" value="" spellcheck="false" placeholder="Surname (*)">
               <input type="text" id="Editbox3" style="position:absolute;left:660px;top:18px;width:294px;height:25px;z-index:2;" name="Email" value="" spellcheck="false" placeholder="E-mail (*)">
               <input type="text" id="Editbox4" style="position:absolute;left:9px;top:71px;width:294px;height:25px;z-index:3;" name="Phone" value="" spellcheck="false" placeholder="Phone (*)">
               <input type="number" id="Editbox5" style="position:absolute;left:335px;top:71px;width:294px;height:25px;z-index:4;" name="Age" value="" spellcheck="false" placeholder="Your Age (*)">
               <select name="Query Type" size="1" id="Combobox1" style="position:absolute;left:660px;top:71px;width:300px;height:35px;z-index:5;" autocomplete="off">
                  <option value="Query Type">Query Type</option>
                  <option value="Arrange Appointment">Arrange Appointment</option>
                  <option value="Account Query">Account Query</option>
                  <option value="Medical Query">Medical Query</option>
               </select>
               <textarea name="Comment" id="TextArea1" style="position:absolute;left:9px;top:124px;width:945px;height:174px;z-index:6;" rows="11" cols="116" autocomplete="off" spellcheck="false" placeholder="Comment (*)"></textarea>
               <input type="submit" id="Button2" name="Submit" value="Submit" style="position:absolute;left:327px;top:322px;width:150px;height:35px;z-index:7;">
               <input type="reset" id="Button1" name="Clear" value="Reset" style="position:absolute;left:521px;top:322px;width:150px;height:35px;z-index:8;">
               <div id="wb_Captcha1" style="position:absolute;left:12px;top:312px;width:268px;height:45px;z-index:9;">
                  <img src="captcha1.php" alt="Click for new image" title="Click for new image" style="cursor:pointer;float:left;width:100px;height:38px;" onclick="this.src='captcha1.php?'+Math.random()">
                  <span><input type="text" id="Captcha1" style="margin-top:14px;width:calc(100% - 4px);height:20px;" name="captcha" value="" spellcheck="false"></span></div>
               <div id="wb_Extension2" style="position:absolute;left:813px;top:288px;width:120px;height:69px;z-index:10;">
               </div>
            </form>
         </div>
         <div id="wb_Text13" style="position:absolute;left:10px;top:446px;width:252px;height:26px;z-index:23;">
            <span style="color:#606060;font-family:Candara;font-size:21px;"><strong><u>Practice Hours</u></strong></span></div>
         <div id="wb_Text14" style="position:absolute;left:478px;top:480px;width:249px;height:20px;z-index:24;">
            <span style="color:#606060;font-family:Candara;font-size:16px;"><strong>Benoni Practice Office Hours</strong></span></div>
         <div id="wb_Text16" style="position:absolute;left:490px;top:539px;width:153px;height:18px;z-index:25;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">16:30 PM - 18:00PM</span></div>
         <div id="wb_Text15" style="position:absolute;left:490px;top:573px;width:191px;height:18px;z-index:26;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">Saturday</span></div>
         <div id="wb_Text17" style="position:absolute;left:31px;top:573px;width:246px;height:18px;z-index:27;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">Office</span></div>
         <div id="wb_Text19" style="position:absolute;left:490px;top:591px;width:244px;height:18px;z-index:28;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">7:30 - 10:30 AM</span></div>
         <div id="wb_Text18" style="position:absolute;left:46px;top:591px;width:245px;height:18px;z-index:29;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">Monday - Friday</span></div>
         <div id="wb_Text20" style="position:absolute;left:478px;top:503px;width:80px;height:18px;z-index:30;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">Dr. Novis</span></div>
         <div id="wb_Text27" style="position:absolute;left:337px;top:167px;width:276px;height:20px;z-index:31;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">Cell: (073) 244-6875 </span></div>
         <div id="wb_Text21" style="position:absolute;left:10px;top:480px;width:249px;height:20px;z-index:32;">
            <span style="color:#606060;font-family:Candara;font-size:16px;"><strong>Springs Practice Office Hours</strong></span></div>
         <div id="wb_Text22" style="position:absolute;left:31px;top:503px;width:80px;height:18px;z-index:33;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">Dr. Novis</span></div>
         <div id="wb_Text23" style="position:absolute;left:46px;top:521px;width:191px;height:18px;z-index:34;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">Monday, Wednesday, Friday</span></div>
         <div id="wb_Text24" style="position:absolute;left:46px;top:539px;width:153px;height:18px;z-index:35;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">8:00 - 10:00 AM</span></div>
         <div id="wb_Text26" style="position:absolute;left:46px;top:609px;width:244px;height:18px;z-index:36;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">8:00 - 16:00</span></div>
         <div id="wb_Text25" style="position:absolute;left:490px;top:521px;width:191px;height:18px;z-index:37;">
            <span style="color:#606060;font-family:Candara;font-size:15px;">Tuesday</span></div>
         <div id="wb_Text6" style="position:absolute;left:337px;top:74px;width:253px;height:23px;z-index:38;">
            <span style="color:#606060;font-family:Candara;font-size:19px;"><strong>Springs Practice</strong></span></div>
         <div id="wb_Text7" style="position:absolute;left:337px;top:105px;width:306px;height:20px;z-index:39;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">10 Gillespie Road, Selection Park, Springs</span></div>
         <div id="wb_Text4" style="position:absolute;left:10px;top:74px;width:133px;height:23px;z-index:40;">
            <span style="color:#606060;font-family:Candara;font-size:19px;"><strong>Benoni Practice</strong></span></div>
         <div id="wb_Text10" style="position:absolute;left:11px;top:167px;width:250px;height:20px;z-index:41;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">Tel: (011) 815- 1117 </span></div>
         <div id="wb_Text28" style="position:absolute;left:10px;top:136px;width:250px;height:20px;z-index:42;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">Email: clivenovis@mweb.co.za</span></div>
      </div>
   </div>
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         <div id="wb_FTText1" style="position:absolute;left:10px;top:9px;width:133px;height:23px;z-index:54;">
            <span style="color:#606060;font-family:Candara;font-size:19px;"><strong>Dr Clive Novis</strong></span></div>
         <div id="wb_FTText2" style="position:absolute;left:10px;top:32px;width:214px;height:57px;z-index:55;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">Dip.Optom MBBCH<br>FCS (Oph). MMED.<br>PR. No. 2603616</span></div>
         <div id="wb_FTClipArt1" style="position:absolute;left:330px;top:17px;width:29px;height:27px;z-index:56;">
            <img src="images/img0003.png" id="FTClipArt1" alt="" style="width:29px;height:27px;"></div>
         <div id="wb_FTText3" style="position:absolute;left:373px;top:9px;width:250px;height:19px;z-index:57;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">23 Sunnyside Ave, Westdene, Benoni</span></div>
         <div id="wb_FTText4" style="position:absolute;left:373px;top:32px;width:292px;height:20px;z-index:58;">
            <span style="color:#606060;font-family:Candara;font-size:16px;">10 Gillespie Street, Selection Park, Springs</span></div>
         <div id="wb_FTClipArt2" style="position:absolute;left:333px;top:61px;width:23px;height:25px;z-index:59;">
            <img src="images/img0004.png" id="FTClipArt2" alt="" style="width:23px;height:25px;"></div>
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            <span style="color:#606060;font-family:Candara;font-size:16px;"> (011) 815-1117 </span></div>
         <div id="wb_FTText6" style="position:absolute;left:898px;top:9px;width:86px;height:19px;z-index:61;">
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