Contact

Radiance Laser Skin Clinic
1st Floor, Krishna Hospital
Vidyanagar, Kasaragod – 671 123
Kerala, India
Phone: +91 (0) 4994 253400
Fax: +91 (0) 4994 255993

Krishna Hospital
Vidyanagar, Kasaragod 671 123
Kerala, India
Phone: +91 (0) 4994 256719
Fax: +91 (0) 4994 255993


Name
Address
Profession
Telephone
Email
Location
Message

<% Name = Request.Form("name") Address= Request.Form("Address") Profession= Request.Form("profession") Telephone = Request.Form("Telephone") Location = Request.Form("Location") Email = Request.Form("Email") Comments= Request.Form("comments") IPAddress=trim(Request.ServerVariables("REMOTE_ADDR")) IF Name <> "" AND Email <>"" AND Comments <>"" THEN Dim objMail Set objMail = CreateObject("CDONTS.NewMail") objMail.BodyFormat = 0 objMail.MailFormat = 0 TXT= "

"&Name&"

"&Address&"

"&Profession&"

"&Telephone&"

"&Location&"

"&Email&"

"&Comments&"

accuversa

" objMail.Body = TXT objMail.Send "sales@accuversa.com", "pratheesh@accuversa.com;joseph@accuversa.com;dominic@accuversa.com","www.accuversa.com - sales : "&Name&"",TXT Set objMail = Nothing %> <% ELSE END IF %>