UPMC Pinnacle BU > CloudPages > API Internal Testing Forms > We Deliver Joy CPa - TEST FORM


      <h2>We Deliver Joy CPa - Test Form</h2>
      <form action="https://pages.upmc.com/we-deliver-joy-cpa-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>Zip Code</label>
         <input type="text" name="zip_code"><br><br>

         <label>I would like to learn more about:</label><br>
            <select name="interest" id="interest" multiple>
               <option value="Women’s Health">Women’s Health</option>
               <option value="Pregnancy and Labor Services">Pregnancy and Labor Services</option>
            </select><br><br>

         <label><strong>Women’s Health</strong> <br> <em>(enter 'True' or 'False' matching your selection from the 'I would like to learn more about:' field above)</em></label>
         <input type="text" name="interest_womenshealth"><br><br>

         <label><strong>Pregnancy and Labor Services</strong> <br> <em>(enter 'True' or 'False' matching your selection from the 'I would like to learn more about:' field above)</em></label>
         <input type="text" name="interest_pregnancylabor"><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>
         <input name="submitted" type="hidden" value="true" />
         <input type="submit" value="Submit">
      </form>