$temp_profile->d_o_b = $fullDob;
$temp_profile->driving_licence = mysql_real_escape_string($_REQUEST['driving_licence']);
$temp_profile->user_address = mysql_real_escape_string($_REQUEST['user_address']);
$temp_profile->user_state = mysql_real_escape_string($_REQUEST['user_state']);
$temp_profile->user_city = mysql_real_escape_string($_REQUEST['user_city']);
$temp_profile->zip_code = mysql_real_escape_string($_REQUEST['zip_code']);
$temp_profile->doctor_name = mysql_real_escape_string($_REQUEST['doctor_name']);
$temp_profile->client_email = mysql_real_escape_string($_REQUEST['client_email_address']);
$case_type = "2";
$auto_insurance = "";
/*Convert to small letters*/
$username = strtolower(mysql_real_escape_string($_REQUEST['plantiff_name']));
$u_name1 = preg_replace('/\\s/', '', $username);
$temp_profile->u_name = $u_name1;
$ssn_no = "";
$var = $temp_profile->OldUser($case_type, $auto_insurance, $ssn_no);
$emails = mysql_real_escape_string($_REQUEST['email_address']);
$_SESSION['email'] = $emails;
if ($var = 1) {
echo "<div class='thank_message'>\n\t\t\t\t\tForm Submitted Sucessfully. You will redirected to next step shortly. Don't close the browser.</div>";
header("Refresh:2;url={$sitepath}/attorney/meshed-form/meshed-step-2.php/");
} else {
echo "<div class='thank_message'>Email Sending Failed</div>";
}
}
?>
<div class="container client_application">
<h1>Mesh Registration Form</h1>
<form name="registration" id="registration" method="post" action="">
<span class="error"></span>
<div class="client_1">
$meshedform->office_no = mysql_real_escape_string($_REQUEST['office_no']);
$meshedform->email_address = mysql_real_escape_string($_REQUEST['email_address']);
$meshedform->d_o_b = mysql_real_escape_string($_REQUEST['d_o_b']);
$meshedform->driving_licence = mysql_real_escape_string($_REQUEST['driving_licence']);
$meshedform->user_address = mysql_real_escape_string($_REQUEST['user_address']);
$meshedform->user_state = mysql_real_escape_string($_REQUEST['user_state']);
$meshedform->user_city = mysql_real_escape_string($_REQUEST['user_city']);
$meshedform->zip_code = mysql_real_escape_string($_REQUEST['zip_code']);
$meshedform->doctor_name = mysql_real_escape_string($_REQUEST['doctor_name']);
$case_type = "4";
$auto_insurance = " ";
/*Convert to small letters*/
$username = strtolower(mysql_real_escape_string($_REQUEST['plantiff_name']));
$u_name1 = preg_replace('/\\s/', '', $username);
$meshedform->u_name = $u_name1;
$var = $meshedform->OldUser($case_type, $auto_insurance);
echo $emails = mysql_real_escape_string($_REQUEST['email_address']);
echo $_SESSION['email'] = $emails;
if ($var = 1) {
echo "<div id='e_message'>Your Login Information has been sent to your Email</div>";
header("Refresh:8;url={$sitepath}/attorney/meshed-form/meshed-step-2.php/");
} else {
echo "<div id='e_message'>Email Sending Failed</div>";
}
}
require $get_footer;
} else {
header('Location:../../login.php');
}
?>
<link rel="stylesheet" href="//code.jquery.com/ui/1.11.1/themes/smoothness/jquery-ui.css">
