-None-
Friend/Family
Internet
Google
Facebook
Instagram
Twitter
Newspaper
Radio
TV
Direct Mail
Doctor
Email
Landing Page
MVF
NJ Cops
Magazine
NJ Teachers
Pricing Opt-In
LASIK Self Test
Pricing Calculator
Website
CLI Self Test
Visian ICL Self Test
Kerato Self Test
Other
-None-
Free Virtual Consultation
Contact Us
Manhattan NYC Form
Roslyn NY Form
Paramus NJ Form
Edison NJ Form
LASIK Self Test
Pricing Calculator
Pricing Opt-In
SMILE Webinar
Brochure
MLC Patient Guide
CLI Self Test
Visian ICL Self Test
Kerato Self Test
Captcha validation failed. If you are not a robot then please try again.
/* Do not remove this code. */
function rccallback1444504000145058001()
{
if(document.getElementById('recap1444504000145058001')!=undefined){
document.getElementById('recap1444504000145058001').setAttribute('captcha-verified',true);
}
if(document.getElementById('recapErr1444504000145058001')!=undefined && document.getElementById('recapErr1444504000145058001').style.visibility == 'visible' ){
document.getElementById('recapErr1444504000145058001').style.visibility='hidden';
}
}
function reCaptchaAlert1444504000145058001()
{
var recap = document.getElementById('recap1444504000145058001');
if( recap !=undefined && recap.getAttribute('captcha-verified') == 'false')
{
document.getElementById('recapErr1444504000145058001').style.visibility='visible';
return false;
}
return true;
}
function validateEmail1444504000145058001()
{
var form = document.forms['WebForm1444504000145058001'];
var emailFld = form.querySelectorAll('[ftype=email]');
var i;
for (i = 0; i < emailFld.length; i++)
{
var emailVal = emailFld[i].value;
if((emailVal.replace(/^\s+|\s+$/g, '')).length!=0 )
{
var atpos=emailVal.indexOf('@');
var dotpos=emailVal.lastIndexOf('.');
if (atpos<1 || dotpos=emailVal.length)
{
alert('Please enter a valid email address. ');
emailFld[i].focus();
return false;
}
}
}
return true;
}
function checkMandatory1444504000145058001() {
var mndFileds = new Array('Email','COBJ5CF1','COBJ5CF2','COBJ5CF4','COBJ5CF9');
var fldLangVal = new Array('Email','First\x20Name','Last\x20Name','Mobile','Message');
for(i=0;i<mndFileds.length;i++) {
var fieldObj=document.forms['WebForm1444504000145058001'][mndFileds[i]];
if(fieldObj) {
if (((fieldObj.value).replace(/^\s+|\s+$/g, '')).length==0) {
if(fieldObj.type =='file')
{
alert('Please select a file to upload.');
fieldObj.focus();
return false;
}
alert(fldLangVal[i] +' cannot be empty.');
fieldObj.focus();
return false;
} else if(fieldObj.nodeName=='SELECT') {
if(fieldObj.options[fieldObj.selectedIndex].value=='-None-') {
alert(fldLangVal[i] +' cannot be none.');
fieldObj.focus();
return false;
}
} else if(fieldObj.type =='checkbox'){
if(fieldObj.checked == false){
alert('Please accept '+fldLangVal[i]);
fieldObj.focus();
return false;
}
}
try {
if(fieldObj.name == 'Last Name') {
name = fieldObj.value;
}
} catch (e) {}
}
}
if(!validateEmail1444504000145058001()){return false;}
if(!reCaptchaAlert1444504000145058001()){return false;}
var urlparams = new URLSearchParams( window.location.search);
if(urlparams.has('service') && (urlparams.get('service')==='smarturl')){
var webform = document.getElementById('webform1444504000145058001');
var service = urlparams.get('service');
var smarturlfield = document.createElement('input');
smarturlfield.setAttribute('type','hidden');
smarturlfield.setAttribute('value',service);
smarturlfield.setAttribute('name','service');
webform.appendChild(smarturlfield);
}
document.querySelector('.crmWebToEntityForm .formsubmit').setAttribute('disabled', true);
}
function tooltipShow1444504000145058001(el){
var tooltip = el.nextElementSibling;
var tooltipDisplay = tooltip.style.display;
if(tooltipDisplay == 'none'){
var allTooltip = document.getElementsByClassName('zcwf_tooltip_over');
for(i=0; i<allTooltip.length; i++){
allTooltip[i].style.display='none';
}
tooltip.style.display = 'block';
}else{
tooltip.style.display='none';
}
}
document.addEventListener('DOMContentLoaded', function() {
// Función para obtener el valor de un parámetro de la URL
function getParameterByName(name) {
name = name.replace(/[\[]/, "\\[").replace(/[\]]/, "\\]");
var regex = new RegExp("[\\?&]" + name + "=([^&#]*)"),
results = regex.exec(location.search);
return results === null ? "" : decodeURIComponent(results[1].replace(/\+/g, " "));
}
// Obtener el valor del parámetro gclid
var gclidValue = getParameterByName('gclid');
// Completar el campo gclid en el formulario
var gclidField = document.getElementById('COBJ5CF16');
if (gclidField) {
gclidField.value = gclidValue;
}
// Enviar el formulario cuando se presione el botón de envío
var form = document.getElementById('myForm');
form.addEventListener('submit', function(event) {
// Aquí puedes realizar cualquier acción adicional antes de enviar el formulario
console.log('Formulario enviado con gclid:', gclidField.value);
});
});
WARNING: Internet Explorer does not support modern web standards. This site may not function
correctly on this browser and is best viewed on
Chrome,
Firefox
or Edge
browsers.
Learn More.
