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	<title>clinica</title>
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<body>

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<div id="contenedor">
	<!-- header -->
	<div id="header">
	<div class="bg_logo"><h1><a href="http://www.clinicasanfelipe.com/CSF">Cl&iacute;nica San Felipe</a></h1></div>
		<div class="ban_telefonista">
<img src="img/banner.jpg" width="777" height="98" alt="" />
			<ul class="sociales">S&iacute;guenos
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    	<ul id="menu-menu-principal" class="menu">
   
   <li id="menu-item-1021" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-1021"><a href="index.html">INICIO</a>
  
</li>
<li id="menu-item-1022" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-1022"><a href="nosotros.html">NOSOTROS</a>

</li>
<li id="menu-item-1588" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-1588"><a href="servicios.html">SERVICIOS</a>

</li>
<li id="menu-item-1023" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-1023"><a href="clientes.html">CLIENTE</a>

</li>
<li id="menu-item-1617" class="menu-item menu-item-type-taxonomy menu-item-object-category menu-item-1617"><a href="certificacion.html">CERTIFICACIONES</a></li>
<li id="menu-item-1617" class="menu-item menu-item-type-taxonomy menu-item-object-category menu-item-1617"><a href="legislacion.html">LOGISTICA</a></li>
<li id="menu-item-1617" class="menu-item menu-item-type-taxonomy menu-item-object-category menu-item-1617" ><a href="contactenos.php">CONTACTENOS</a></li>
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		<!--content-->
	  <div style="float: left;
	width: 896px;
	margin: 15px 0 0 0;
	position: relative;">
        <h2>Contactenos</h2>
          <!--  formulario  
          
          -->
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        </div>
        <div  style="float:right; padding-top:9px; width:320px;">
 <!-- Codigo php -->

			
			<!--<div class="box1"> -->
				
		<div class="col-4 left-2">
        	
              <?php
        function isEmail($email)
        {
            return(preg_match("/^[-_.[:alnum:]]+@((([[:alnum:]]|[[:alnum:]][[:alnum:]-]*[[:alnum:]])\.)+(ad|ae|aero|af|ag|ai|al|am|an|ao|aq|ar|arpa|as|at|au|aw|az|ba|bb|bd|be|bf|bg|bh|bi|biz|bj|bm|bn|bo|br|bs|bt|bv|bw|by|bz|ca|cc|cd|cf|cg|ch|ci|ck|cl|cm|cn|co|com|coop|cr|cs|cu|cv|cx|cy|cz|de|dj|dk|dm|do|dz|ec|edu|ee|eg|eh|er|es|et|eu|fi|fj|fk|fm|fo|fr|ga|gb|gd|ge|gf|gh|gi|gl|gm|gn|gov|gp|gq|gr|gs|gt|gu|gw|gy|hk|hm|hn|hr|ht|hu|id|ie|il|in|info|int|io|iq|ir|is|it|jm|jo|jp|ke|kg|kh|ki|km|kn|kp|kr|kw|ky|kz|la|lb|lc|li|lk|lr|ls|lt|lu|lv|ly|ma|mc|md|mg|mh|mil|mk|ml|mm|mn|mo|mp|mq|mr|ms|mt|mu|museum|mv|mw|mx|my|mz|na|name|nc|ne|net|nf|ng|ni|nl|no|np|nr|nt|nu|nz|om|org|pa|pe|pf|pg|ph|pk|pl|pm|pn|pr|pro|ps|pt|pw|py|qa|re|ro|ru|rw|sa|sb|sc|sd|se|sg|sh|si|sj|sk|sl|sm|sn|so|sr|st|su|sv|sy|sz|tc|td|tf|tg|th|tj|tk|tm|tn|to|tp|tr|tt|tv|tw|tz|ua|ug|uk|um|us|uy|uz|va|vc|ve|vg|vi|vn|vu|wf|ws|ye|yt|yu|za|zm|zw)$|(([0-9][0-9]?|[0-1][0-9][0-9]|[2][0-4][0-9]|[2][5][0-5])\.){3}([0-9][0-9]?|[0-1][0-9][0-9]|[2][0-4][0-9]|[2][5][0-5]))$/i",$email));
        };
        //-- variables
        $error='';
        $nombres='';
        $apellidos='';
        $correo='';
		$telefono='';
	
		$mensaje='';
       
        
        if(isset($_POST["enviar"]))  
		{
            //-- capturar variables
			$nombres=$_POST["nombres"];
			$apellidos= $_POST["apellidos"];
            $correo=$_POST["correo"];
			$telefono= $_POST["telefono"];
			$mensaje=$_POST["mensaje"];

            //-- cuerpo del mensaje
            $cuerpo.='<html></body><table width="200" cellspacing="0" cellpadding="5">';
            $cuerpo.='<tr><td width="200" style="font-family:tahoma;  font-size:12px; color:#FFFFFF; background-color:#547c99"><b>Datos personales</b></td></tr><tr>';
            $cuerpo.='<td style="font-family:tahoma; font-size:12px"><p>';
            /*$cuerpo.='<b>Tour:</b> '.$tour.'<br />';*/
           /* $cuerpo.='<b>Date of tour:</b> '.$arrival.'<br />';*/
		    $cuerpo.='<b>Nombre:</b> '.$nombres.'<br />';
			$cuerpo.='<b>Apellidos:</b> '.$apellidos.'<br />';
			$cuerpo.='<b>Correo:</b> '.$correo.'<br />';
			$cuerpo.='<b>Telefono:</b> '.$telefono.'<br />';
            $cuerpo.='<b>Mensaje:</b> '.$mensaje.'<br />';
            $mensaje2=$cuerpo.'<b>IP:</b> '.$_SERVER['REMOTE_ADDR'].'<br /></td></tr></table></body></html>';                
            $cuerpo.='</td></tr></table></body></html>';
            $message  = $cuerpo;
            //-- validaciones
            if(trim($nombres) == '')
            {
                $error = '<div class="errormsg">Por favor,Ingrese su nombre!</div>';
            }
            else if(trim($correo) == '')
            {
                $error = '<div class="errormsg">Por favor,Por favor ingrese su correo!</div>';
            }
            else if(!isEmail($correo))
            {
                $error = '<div class="errormsg">You must enter an invalid e-mail. por favor intente otra vez!</div>';
            }
            
            if($error=='') 
			{
                //-- implementacion de captcha
                //include("securimage/securimage.php");
                //$img = new Securimage();
                //$valid = $img->check($_POST['code']);
                //-- si fue valido el codigo del captcha
                //if($valid == '')
                //{
                    if(get_magic_quotes_gpc())
                        $message = stripslashes($message);
                    
			 $to = "informes@pmcergonomic.com";
                   $copiax ="info@mb-onweb.com";

                    //-- asunto del email
                    $subject='Mensaje desde Ergonomic '. $subject;
                    //-- cabecera
                    $cabecera = 'From:'.$correo. "\r\n" .'Reply-To:'. $correo . "\r\n" .'X-Mailer: PHP/' . phpversion(). "\r\n" .
					'Bcc:' .$copiax. "\r\n" .
					'Content-type: text/html; charset=iso-8859-1'."\r\n";
                    
                    if(mail($to, $subject, $mensaje2, $cabecera))
					{
                  
               ?>
                  
   <div style="text-align:left;">
    <h3 class="h3-line">Solicitud enviada </h3>
       <p>Gracias <b><?=$nombres;?></b>,por confiar en Medical Center Ergonomic</p>
                               <? echo $message; ?>
                        
                     
                  </div>
				  
                          <!--End Message Sent-->
                    <?php
                    }
                    else{
                        echo('<strong>Hay problemas al enviar su solicitud, por favor intente mas tarde.</strong><br>');}
                    }
                }

        
        
        if(!isset($_POST['enviar']) || $error != '')
        {
 ?>
            <!--Error Message-->
            <?=$error;?>
            
 <form id="form" method="post" >
    <fieldset>
    <legend style="background-color:#0e4b9b;
    color: #FFF;
    font: bold 17px/21px Calibri,Arial,Helvetica,sans-serif;
    padding: 0px 10px;
    text-transform: uppercase;
}">Datos Personales</legend>
      <table width="317">
      
        <tr>
          <td width="100" height="30"><label><strong>Nombre:
            
          </strong></label></td>
          <td><strong>
            <input type="text" value="" name="nombres"/>
          </strong></td>
        </tr> <br/>
         <tr>
          <td width="100" height="30"><label><strong>Apellidos:</strong></label></td>
          <td><input type="text" value="" name="apellidos"/></td>
        </tr>
        <tr>
          <td width="100" height="30"><label><strong>Correo:</strong></label></td>
          <td><input type="text" value="" name="correo"/></td>
        </tr>
        <tr>
        <td height="30"><label><strong>Telefono:</strong> </label></td>
          <td height="30" ><input type="text" value="" name="telefono"/></td>
        </tr>
        
        
  <tr>
    <td>
  <label><strong>Especificar su solicitud:
    </strong> </label>
  <td height="40"><textarea style="width:150px; height:60px;" name="mensaje"></textarea>
  </strong></td>
  
  </tr>
 

      </table> 
      <br/>
<input style="width:50px; height:30px;" type="submit" name="enviar" id="send" value="Enviar">
              <input style="width:50px; height:30px;" type="reset" name="send" id="send2" value="Borrar">
</fieldset>

   <?php
        }
        ?>
          </form>
        </div>		
        	
	  </div>
       	
    		
	</div> 
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<div id="footer" style="color:#FFF;">
  					<p>Av. de la Cultura N° 1522- Tercer Nivel - Edificio Sao Paulo - Wanchap</p>
  
  					<p>Telf: (084) 231944 Cel: 984 - 306900 / 984 - 729207</p>
  
  					<p>wsantos@ergonomic.com.pe / rrodrigo@ergonomic.com.pe</p>
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