CHP BU > CloudPages > API Internal Testing Forms > CHP Navigation Information Request - TEST FORM


      <h2>CHP Navigation Information Request - Test Form</h2>
      <form action="https://pages.upmc.com/chp-navigation-information-request-api-internal-testing-form" method="post">
         <label>Email</label>
         <input type="text" name="email_address"><br>
         <label>Full Name</label>
         <input type="text" name="full_name"><br>
         <label>Phone Number</label>
         <input type="text" name="phone_number"><br><br>
         
         <label>Preferred Method of Contact</label>
            <select name="contact_method" id="contact_method">
               <option value="" selected="selected">Select One</option>
               <option value="Email">Email</option>
               <option value="Phone">Phone</option>
            </select><br><br>

         <label>Comments</label>
            <textarea type="text" name="comments"></textarea><br><br>
         
         <label>Service Line</label>
         <input type="text" name="service_line"><br>
         <label>Category</label>
         <input type="text" name="category"><br>
         <label>Subcategory</label>
         <input type="text" name="subcategory"><br>
         <input name="submitted" type="hidden" value="true" />
         <input type="submit" value="Submit">
      </form>