UPMC BU > CloudPages > API Internal Testing Forms > UPMC East Above and Beyond - TEST FORM


      <h2>UPMC East Above and Beyond - Test Form</h2>
      <form action="https://pages.upmc.com/upmceast-above-and-beyond-api-internal-testing-form" method="post">
         <label>Email</label>
         <input type="text" name="email_address"><br>
         <label>Your Name</label>
         <input type="text" name="full_name"><br>
         <label>Patient Name (if you're not the patient)</label>
         <input type="text" name="patient_name"><br>
         <label>Department</label>
         <input type="text" name="department"><br>
         <label>I would like to recognize</label>
         <input type="text" name="recognition"><br>
         <label>Please share your story with us and include as much detail as possible:</label>
         <textarea type="text" name="comments"></textarea><br> <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>