UPMC BU > CloudPages > API Internal Testing Forms > Magee Contact Form - TEST FORM


      <h2>Magee Contact Form - Test Form</h2>
      <form action="https://pages.upmc.com/magee-contact-form-api-internal-testing-form" method="post">
         <label>Email</label>
         <input type="text" name="email_address"><br>
         <label>First Name</label>
         <input type="text" name="first_name"><br>
         <label>Last Name</label>
         <input type="text" name="last_name"><br>
         <label>Phone Number</label>
         <input type="text" name="phone_number"><br>
         <label>Zip Code</label>
         <input type="text" name="zip_code"><br>

         <label>Reason for Contacting Magee</label>
            <select name="reason_for_inquiry" id="reason_for_inquiry">
               <option value="" selected="selected">Select One</option>
               <option value="Careers and Training">Careers and Training</option>
               <option value="Classes and Events">Classes and Events</option>
               <option value="Compliments">Compliments</option>
               <option value="Donating to Magee">Donating to Magee</option>
               <option value="Financial Questions">Financial Questions</option>
               <option value="Medical Records">Medical Records</option>
               <option value="Patient Experience">Patient Experience</option>
               <option value="Volunteering at Magee">Volunteering at Magee</option>
            </select><br>
<br>

         <label>Category</label>
         <input type="text" name="category"><br>
         <label>Subcategory</label>
         <input type="text" name="subcategory"><br>
        <br>
        <div style="background-color:#96B8B9;padding:20px 15px 5px 15px;width:450px;">
          <label><strong>Captcha Score</strong></label>         <input type="text" name="captcha_score"><br>
        <ul>
          <li><strong>0-70</strong> will fire the TY email</li>
  <li><strong>71-80</strong> will fire the hcaptcha verification email</li>
  <li><strong>81 and above</strong> will destroy your life</li>
        </ul>
        </div>
        <br>
         <input name="submitted" type="hidden" value="true" />
         <input type="submit" value="Submit">
      </form>