Patient Insurance Update Form
ILLEGAL ENTRY IN THE EMAIL ADDDRESS!
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THERE IS AN ILLEGAL ENTRY IN THE EMAIL ADDDRESS!
PLEASE USE THE BACK KEY ON YOUR BROWSER TO FIX THE EMAIL ADDRESS
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THERE IS AN ILLEGAL ENTRY IN THE EMAIL ADDDRESS!
PLEASE USE THE BACK KEY ON YOUR BROWSER TO FIX THE EMAIL ADDRESS
THANK YOU!
THERE IS AN ILLEGAL ENTRY IN THE EMAIL ADDDRESS!
PLEASE USE THE BACK KEY ON YOUR BROWSER TO FIX THE EMAIL ADDRESS
THANK YOU!
THERE IS AN ILLEGAL ENTRY IN THE EMAIL ADDDRESS!
PLEASE USE THE BACK KEY ON YOUR BROWSER TO FIX THE EMAIL ADDRESS
THANK YOU!
THERE IS AN ILLEGAL ENTRY IN THE EMAIL ADDDRESS!
PLEASE USE THE BACK KEY ON YOUR BROWSER TO FIX THE EMAIL ADDRESS
THANK YOU!
THERE IS AN ILLEGAL ENTRY IN THE EMAIL ADDDRESS!
PLEASE USE THE BACK KEY ON YOUR BROWSER TO FIX THE EMAIL ADDRESS
THANK YOU!
THERE IS AN ILLEGAL ENTRY IN THE EMAIL ADDDRESS!
PLEASE USE THE BACK KEY ON YOUR BROWSER TO FIX THE EMAIL ADDRESS
THANK YOU!
THERE IS AN ILLEGAL ENTRY IN THE EMAIL ADDDRESS!
PLEASE USE THE BACK KEY ON YOUR BROWSER TO FIX THE EMAIL ADDRESS
THANK YOU!
THERE IS AN ILLEGAL ENTRY IN THE EMAIL ADDDRESS!
PLEASE USE THE BACK KEY ON YOUR BROWSER TO FIX THE EMAIL ADDRESS
THANK YOU!
OOPS! ONE OF THE FIELDS IN THE INSURANCE FORM IS BLANK.
PLEASE USE THE BACK KEY ON YOUR BROWSER TO ENTER THE MISSING INFORMATION
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Please follow the link INSURANCE UPDATE"; $from = "AJHinquiry@easypay.com"; $headers = "From: $from"; $headers = "From: $from"."\n" ; $headers = "From: inquiryajh@bpltd.net"."\n" ; $headers .= "Content-type: text/html; charset=iso-8859-1"."\r\n" ."X-Mailer: php "."\n"; if ( $enumb == "" ){ die ("could not send to server email not completed"); } require_once('ses.php'); $ses = new SimpleEmailService('AKIAJQQ5ATRMO2M3DJAQ', 'GKG0mn5MYkiCumPcyUsK0XZHrtfPHS+BQ4dem5Wm'); $recipient = "Shirley.tetreault@weeksmedical.org"; $recipient2 = "Zachary.colby@weeksmedical.org"; $recipient3 = "bpike@bpltd.net"; $m = new SimpleEmailServiceMessage(); $m->addTo($recipient); $m->addTo(array($recipient2)); $m->addTo(array($recipient3)); $m->addBCC('bpike@credit-services.com'); $m->setFrom('"Customer Inquiry Weeks Medical Center"
YOUR INSURANCE INFORMATION HAS BEEN SENT
We will send you a confirmation within 24 hours.
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