BusinessUnit BU > Cloud Pages > API Internal Testing Forms > Sports Medicine SWPA Contact Form - TEST FORM


      <h2>Sports Medicine SWPA Contact Form - Test Form</h2>
      <form action="https://pages.upmc.com/sports-medicine-swpa-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><br>

         <label>Preferred location:</label>
            <select name="location" id="location">
              <option value="" selected="selected">Select One</option>
              <option value="UPMC Lemieux Sports Complex (Cranberry Township)">UPMC Lemieux Sports Complex (Cranberry Township)</option>
              <option value="UPMC Rooney Sports Complex (Pittsburgh - South Side)">UPMC Rooney Sports Complex (Pittsburgh - South Side)</option>
            </select><br><br>

          <label>I am looking for:</label>
            <select name="interest" id="interest">
              <option value="" selected="selected">Select One</option>
              <option value="Physician or surgeon">Physician or surgeon</option>
              <option value="Concussion services">Concussion services</option>
              <option value="Physical therapy">Physical therapy</option>
              <option value="Sports performance">Sports performance</option>
              <option value="Sports nutrition">Sports nutrition</option>
            </select><br><br>
         
         <label>Region</label>
         <input type="text" name="region"><br>
         <label>Service Line</label>
         <input type="text" name="service_line"><br><br>

         <label>Category</label>
         <input type="text" name="category"><br>
         <label>Subcategory</label>
         <input type="text" name="subcategory"><br><br>
         <input name="submitted" type="hidden" value="true" />
         <input type="submit" value="Submit">
      </form>