Meet and Greet

[insert_php]

$the_name = $_POST[‘the_name’];
$phone = $_POST[‘phone’];
$email = $_POST[’email’];
$age = $_POST[‘age’];
$sex = $_POST[‘sex’];
$location = $_POST[‘location’];
$married = $_POST[‘married’];
$how_did_you_hear_about_us = $_POST[‘how_did_you_hear_about_us’];
$issue = $_POST[‘issue’];

if (!empty($_POST)) {

$response = $_POST[‘g-recaptcha-response’];

$data = array(
‘secret’ => ‘6LfDoBgTAAAAAFx-uI_J5e5nfq1jnlQ2T0gfagjL’,
‘response’ => $response,
‘remoteip’ => $_SERVER[‘REMOTE_ADDR’]
);

$context = stream_context_create(
array(
‘http’ => array(
‘header’ => “Accept: application/json”,
‘method’ => ‘POST’,
‘content’ => http_build_query($data)
)
)
);

$contents = file_get_contents(“https://www.google.com/recaptcha/api/siteverify”, false, $context);

if ($contents === FALSE || strstr($http_response_header[0], “200 OK”) == FALSE) {
echo ‘

An error occurred.

‘;
}
else {
$decoded = json_decode($contents);
if ($decoded->success) {
if (empty($the_name) or empty($phone) or empty($email) or empty($age) or empty($sex) or empty($location) or empty($issue)) {
echo ‘

Please fill in all of the required fields.

‘;
$failed = TRUE;
}
else {
mail(“Vanessa.cruz@me.com”, “Meet and Greet”, “Name: $the_name\r\nEmail: $email\r\nAge: $age\r\nSex: $sex\r\nLocation: $location\r\nMarital status: $married\r\nHow did you hear about us: $how_did_you_hear_about_us\r\nIssue or problem:\r\n\r\n$issue”);

echo ‘

Your inquiry has been submitted. Thank you.

‘;
}
}
else {
echo ‘

Sorry, you answered the captcha incorrectly.

‘;
$failed = TRUE;
}
}
}
[/insert_php]

Our meet and greet won’t take long… it should last no more than 1 hour and is completely FREE.

Our meeting provides you with the opportunity to meet face-to-face so you can find out all that counseling involves and to talk about what’s troubling you.

1. All meetings will take place at our office location on the northwest side of Chicago.

6015 N Francisco Ave

Chicago, IL 60659

2. I want to get to know you. So, be ready to chat and talk about yourself.

3. This is also your chance to ask any questions you have.

Let’s Meet Up

First & Last Name *


Phone number *


Email Address *

Age *

Gender *
Male
Female

City & State *

Marital Status
Single
Married
Separated
Divorced
Widowed
How did you hear about us?


Please provide a brief description of the issue or problem you are dealing with:

[insert_php]
echo ‘‘;
[/insert_php]