\n"; $showSignupForm = true; // don't change this value } else { // check recaptcha $postdata = array(); $postdata['secret'] = '6Lfd5RcTAAAAANqxhQj_0hqmPJusJAh90pkloOKA'; $postdata['response'] = @$_REQUEST['g-recaptcha-response']; $postdata['remoteip'] = $_SERVER['REMOTE_ADDR']; $url = "https://www.google.com/recaptcha/api/siteverify?". http_build_query($postdata, '', '&'); list($json, $httpStatusCode, $headers, $request) = getPage($url, 5, '', true); $recaptchaResponse = json_decode($json, true); if (!@$recaptchaResponse['success']) { if (is_array(@$recaptchaResponse['error-codes'])) { if (in_array('missing-input-secret', @$recaptchaResponse['error-codes'])) { $errorsAndAlerts .= "There's a problem with recaptcha, please let us know! (no secret)
\n"; } if (in_array('invalid-input-secret', @$recaptchaResponse['error-codes'])) { $errorsAndAlerts .= "There's a problem with recaptcha, please let us know! (invald secret)
\n"; } if (in_array('missing-input-response', @$recaptchaResponse['error-codes'])) { $errorsAndAlerts .= "Please fill out the recaptcha box!
\n"; $showSignupForm = true; // do we need this line? } if (in_array('invalid-input-response', @$recaptchaResponse['error-codes'])) { $errorsAndAlerts .= "Please fill out the recaptcha box again, your answer was incorrect!
\n"; $showSignupForm = true; // do we need this line? } if (!$errorsAndAlerts) { $errorsAndAlerts .= "Invalid captcha response, please try again or contact us directly and let us know."; } @trigger_error("Failed recaptcha on signup form", E_USER_NOTICE); }} } return $errorsAndAlerts; } ?> \n"; } if (!@$_REQUEST['last_name']) { $errorsAndAlerts .= "You must enter a last name
\n"; } if (!@$_REQUEST['practice_name']) { $errorsAndAlerts .= "You must enter the name of the practice
\n"; } if (!@$_REQUEST['practice_street_address']) { $errorsAndAlerts .= "You must enter an address
\n"; } if (!@$_REQUEST['practice_city']) { $errorsAndAlerts .= "You must enter a city
\n"; } if (!@$_REQUEST['practice_state']) { $errorsAndAlerts .= "You must enter a state
\n"; } if (!@$_REQUEST['practice_zip']) { $errorsAndAlerts .= "You must enter a zip/postal code
\n"; } if (!@$_REQUEST['practice_phone']) { $errorsAndAlerts .= "You must enter a phone number
\n"; } if (!@$_REQUEST['email']) { $errorsAndAlerts .= "You must enter your email!
\n"; } else if(!isValidEmail(@$_REQUEST['email'])) { $errorsAndAlerts .= "Please enter a valid email (example: user@example.com)
\n"; } else if (@$_REQUEST['email'] != @$_REQUEST['email2']) { $errorsAndAlerts .= "Your emails must match
\n"; } if (!@$_REQUEST['training_experience']) { $errorsAndAlerts .= "You must describe your DBT training/experience
\n"; } if (!@$_REQUEST['username']) { $errorsAndAlerts .= "You must enter a username
\n"; } $first = $_REQUEST['first_name']; $last = $_REQUEST['last_name']; $address1 = $_REQUEST['practice_street_address']; $room1 = $_REQUEST['practice_room_or_floor']; $city1 = $_REQUEST['practice_city']; $state1 = $_REQUEST['practice_state']; $zip1 = $_REQUEST['practice_zip']; $phone1 = $_REQUEST['practice_phone']; $practice = $_REQUEST['practice_name']; $usernm = $_REQUEST['username']; // $more_than_one_practitioner_in_practice = $_REQUEST['more_than_one_practitioner_in_practice']; // $more_than_one_location_for_practice = $_REQUEST['more_than_one_location_for_practice']; // added _$\^ to preg_match if(preg_match("/[?!\"\[\]\*0-9&#<>\(\)_$\^.]/", $first )){ $errorsAndAlerts .= "
First names can not contain anything except alphabetical characters
\n"; } if(preg_match("/[?!\"\[\]\*0-9&#<>\(\)_$\^.]/", $last )){ $errorsAndAlerts .= "Last names can not contain anything except alphabetical characters
\n"; } if(preg_match("/[?!\"\[\]\*&#<>\(\)_$\^.]/", $practice )){ $errorsAndAlerts .= "Practice names can not contain anything except alphabetical characters
\n"; } if(preg_match("/[?!\"\[\]\*&#<>\(\).]/", $address1)){ $errorsAndAlerts .= "Street addresses can not contain anything except alpha numeric characters
\n"; } if(preg_match("/[?!\"\[\]\*0-9&#<>\(\)_$\^.]/", $city1 )){ $errorsAndAlerts .= "City names can not contain anything except alphabetical characters
\n"; } if(!preg_match("/^[A-Z][A-Z]$/", $state1 )){ $errorsAndAlerts .= "State names must be 2 alphabetical characters long
\n"; } // if(preg_match("/[?!\"\[\]\*0-9{^2,3}&#<>\(\)_$\^.]/", $state1 )){ // $errorsAndAlerts .= "State names can not contain anything except alphabetical characters
\n"; // } if(preg_match("/[?!\"\[\]\*&#<>\(\)_$\^.]/", $zip1 )){ $errorsAndAlerts .= "Zip/postal codes can not contain anything except alphabetical characters
\n"; } if(preg_match("/[?!\"\[\]\*,;:'&#<>\(\)_$\^.-]/", $usernm )){ $errorsAndAlerts .= "Usernames can not contain anything except alphanumeric characters (you can change this after your account is set up.)
\n"; } if(!preg_match("/^[ 0-9]{10,14}$/", @$phone1 )){ $errorsAndAlerts .= "Phone numbers must be 10 or 11 numbers long and can not contain anything but numbers and spaces
\n"; } if(preg_match("/[?\"\[\]\*;&#<>\(\)_$\^]/", @$training_experience )){ $errorsAndAlerts .= "Training/Experience entries can not contain special characters
\n";} if(preg_match("/[?\"\[\]\*;&#<>\(\)_$\^]/", @$practice_room_or_floor )){ $errorsAndAlerts .= "Practice suite, apartment, or floor entries can not contain special characters (like #)
\n";} // check for duplicate usernames and emails if (!$errorsAndAlerts) { $count = mysql_select_count_from('accounts', "`username` = '".mysql_escape(@$_REQUEST['username'])."'"); if ($count > 0 && @$_REQUEST['username']) { $errorsAndAlerts .= "That username is already in use, please choose another!
\n"; } $count = mysql_select_count_from('accounts', "'".mysql_escape($_REQUEST['email'])."' IN (email, username)"); if ($count > 0) { $errorsAndAlerts .= "That email is already in use, please choose another!
\n"; } } // add user if (!$errorsAndAlerts) { // Added 11/1/18 per Daniel at Interactive Tools $more_than_one_location_for_practice = 0; $more_than_one_practitioner_in_practice = 0; $more_than_one_location_for_practicea = 0; $more_than_one_practitioner_in_practicea = 0; if (isset( $_REQUEST['more_than_one_location_for_practice'] )) {$more_than_one_location_for_practice = 1;} $more_than_one_practitioner_in_practice = 0; if (isset( $_REQUEST['more_than_one_practitioner_in_practice'] )) {$more_than_one_practitioner_in_practice = 1;} if ($more_than_one_location_for_practice === 0) { $more_than_one_location_for_practicea = 'there is only one location for this practice.'; } elseif ($more_than_one_location_for_practice === 1) { $more_than_one_location_for_practicea = 'there are multiple locations for this practice.'; } if ($more_than_one_practitioner_in_practice === 0) { $more_than_one_practitioner_in_practicea = 'there is only one practitioner in this practice.'; } elseif ($more_than_one_practitioner_in_practice === 1) { $more_than_one_practitioner_in_practicea = 'there are multiple practitioner in this practice.'; } $addLink = "http://dbtproviders.com/cmsAdmin/admin.php?menu=accounts&action=add"; $addLink .= "&more_than_one_location_for_practice=" .urlencode(@$more_than_one_location_for_practice); $addLink .= "&more_than_one_practitioner_in_practice=" .urlencode(@$more_than_one_practitioner_in_practice); $addLink .= "&username=" .urlencode(@$_REQUEST['username']); $addLink .= "&email=" .urlencode(@$_REQUEST['email']); $addLink .= "&password=" .'2FE3Ur'; $addLink .= "&contact_first_name=" .urlencode(@$_REQUEST['first_name']); $addLink .= "&contact_last_name=" .urlencode(@$_REQUEST['last_name']); $addLink .= "&practice_name=" .urlencode(@$_REQUEST['practice_name']); $addLink .= "&approved=".'1'; $addLink .= "&practice_street_address=" .urlencode(@$_REQUEST['practice_street_address']); $addLink .= "&practice_room_or_floor=" .urlencode(@$_REQUEST['practice_room_or_floor']); $addLink .= "&practice_city=" .urlencode(@$_REQUEST['practice_city']); $addLink .= "&practice_state=" .urlencode(@$_REQUEST['practice_state']); $addLink .= "&practice_zip=" .urlencode(@$_REQUEST['practice_zip']); $addLink .= "&practice_phone=" .urlencode(@$_REQUEST['practice_phone']); $addLink .= "&training_experience=" .urlencode(@$_REQUEST['training_experience']); // send email to Admin $emailHeaders = emailTemplate_loadFromDB(array( 'template_id' => 'DIRECTORY-LISTING-REQUEST', 'placeholders' => array( 'contact.firstName' => ($_REQUEST['first_name']), 'contact.lastName' => ($_REQUEST['last_name']), 'contact.email' => ($_REQUEST['email']), 'contact.username' => ($_REQUEST['username']), 'practice' => ($_REQUEST['practice_name']), 'street' => ($_REQUEST['practice_street_address']), 'room' => ($_REQUEST['practice_room_or_floor']), 'city' => ($_REQUEST['practice_city']), 'state' => ($_REQUEST['practice_state']), 'zip' => ($_REQUEST['practice_zip']), 'more_than_one_location_for_practicea' => ($more_than_one_location_for_practicea), 'more_than_one_practitioner_in_practicea' => ($more_than_one_practitioner_in_practicea), 'phone' => ($_REQUEST['practice_phone']), 'training' => ($_REQUEST['training_experience']), 'addLink' => $addLink, ))); $mailErrors = sendMessage($emailHeaders); if ($mailErrors) { alert("Mail Error: $mailErrors"); } // send email to Applicant $emailHeaders = emailTemplate_loadFromDB(array( 'template_id' => 'DIRECTORY-LISTING-REQUEST-APPLICANT', 'placeholders' => array( 'contact.firstName' => ($_REQUEST['first_name']), 'contact.lastName' => ($_REQUEST['last_name']), 'contact.email' => ($_REQUEST['email']), 'contact.username' => ($_REQUEST['username']), 'practice' => ($_REQUEST['practice_name']), 'room' => ($_REQUEST['practice_room_or_floor']), 'street' => ($_REQUEST['practice_street_address']), 'city' => ($_REQUEST['practice_city']), 'state' => ($_REQUEST['practice_state']), 'zip' => ($_REQUEST['practice_zip']), 'phone' => ($_REQUEST['practice_phone']), 'more_than_one_location_for_practicea' => ($more_than_one_location_for_practicea), 'more_than_one_practitioner_in_practicea' => ($more_than_one_practitioner_in_practicea), 'training' => ($_REQUEST['training_experience']), ))); $mailErrors = sendMessage($emailHeaders); if ($mailErrors) { alert("Mail Error: $mailErrors"); } // show thanks $errorsAndAlerts = "
THANKS FOR SUBMITTING YOUR REQUEST TO BE INCLUDED
IN THE DBT PROVIDER DIRECTORY

Your directory listing request has been sent successfully.

You'll get an email from us after we've reviewed your request.

Best,

The DBT Provider Directory Team
"; $_REQUEST = array(); // clear form values $showSignupForm = false; } ?> LISTING REQUEST - DBT Provider Directory ">
$upload): ?> DBT Provider Directory Masthead
 

USE THIS FORM TO TO LIST YOUR PRACTICE
IN THE DBT PROVIDER DIRECTORY




What's The Name
Of the Practice
The Street Address
Of the Practice
The Suite, Apartment, or Floor (optional)
The City
The State - (2 Letters)
The Zip Code
The Phone Number
Is There More Than One Location For This Practice? (Check If Yes)
 />
What's Your First Name
Your Last Name
Enter A Temporary User Name
Your E-mail Address
Enter Your E-mail Again
Is There More Than One DBT Trained Practitioner In This Practice? (Check If Yes) />
Describe Your DBT Training/Experience
(FOR INTERNAL USE ONLY)

Please check the "I'm not a robot" box below before submitting.


PLEASE ADD THE DBTPROVIDERS.COM DOMAIN
TO YOUR EMAIL SAFE SENDERS LIST

From time to time, we'll be sending you import email messages about your directory listing, and how to update your information to keep it current. Once approved, you'll have to add information to your listing before it goes 'live'.

To insure that you receive these emails, please take a moment right now, even before you submit your lisitng request, and add the domain dbtproviders.com to your safe senders list. If you're not sure how to do that, you can find instructions for many of the most popular email clients HERE.