{"Contact Us"}

{"Let people know what to reach out about and what to expect after contacting you. Don’t forget to choose a storage option for submissions"}

{"inasahealthcare@gmail.com"}
{"(443) 631-3354"}

{"Name:"}
{"Subject:"}
{"Email:"}
{"Message:"}

<br
className={`w-element`} />
<button
type={"submit"}
className={`w-element w-element-84`}>
{"Send Message"}
</button>
<div
id={"contact.responseMessage"}
className={`w-element`} />
</div>
</RemixForm>
<div
className={`w-element w-element-64`}>
<Image
width={1024}
height={1024}
className={`w-image w-image-6`} />
</div>
<HtmlEmbed
executeScriptOnCanvas={true}
code={"<script>\n  document.getElementById('contact.form').addEventListener('submit', function(event) {\n    event.preventDefault(); // Prevent default form submission\n\n    const webhookUrl = 'https://n8n-ai.bsidesolutions.net/webhook-test/9974ca96-98ba-4e56-bb48-debfdad8cf59'; // use Webhook studio Global data var\n    \n    const name = document.getElementById('contact.name').value;\n    const subject = document.getElementById('contact.subject').value;\n    const sender = document.getElementById('contact.email').value;\n    const message = document.getElementById('contact.message').value;\n    const recipient = 'no-reply@inasahealthcare.com'; // use Webhook studio Global data var\n\n    const formData = {\n        name,\n        subject,\n        sender,\n        message,\n        recipient\n    };\n\n    fetch(webhookUrl, {\n        method: 'POST',\n        headers: {\n            'Content-Type': 'application/json' // Or 'application/x-www-form-urlencoded' if your webhook expects that\n        },\n        body: JSON.stringify(formData) // Send data as JSON\n    })\n    .then(response => {\n        if (!response.ok) {\n            throw new Error(`HTTP error! status: ${response.status}`);\n        }\n        return response.json(); // Or response.text() if your webhook doesn't return JSON\n    })\n    .then(data => {\n        document.getElementById('contact.responseMessage').innerText = 'Message sent successfully!';\n        console.log('Success:', data);\n        document.getElementById('contact.form').reset(); // Clear the form\n    })\n    .catch(error => {\n        document.getElementById('contact.responseMessage').innerText = 'Error sending message.';\n        console.error('Error:', error);\n    });\n});\n</script>\n"}
className={`w-html-embed`} />
</div>
</section>
</Fragment_1>
</Slot>
</div>
</div>
<Slot>
<Fragment_1>
<div
className={`w-element w-element-12`}>
<div
href={"/"}
className={`w-element w-element-17`}>
<div
className={`w-element w-element-27`}>
<Link
href={"/"}
className={`w-element w-element-25`}>
<div
className={`w-element w-element-26`}>
<Image
src={"/assets/file_000000003f50722fa551064d566374f2_kdDbKfOW9fojde3YWOccm.png"}
width={1024}
height={1024}
loading={"lazy"}
alt={"logo"}
className={`w-image w-image-2`} />
</div>
</Link>
</div>
<div
className={`w-element w-element-21`}>
<h3
className={`w-element w-element-22`}>
<span
className={`w-element`}>
{"Quick Links"}
</span>
</h3>
<ul
className={`w-element w-element-23`}>
<li
className={`w-element`}>
{"Home"}
</li>
<li
className={`w-element`}>
{"About"}
</li>
<li
className={`w-element`}>
{"Insurance"}
</li>
<li
className={`w-element`}>
{"Services"}
</li>
<li
className={`w-element`}>
{"Contact"}
</li>
</ul>
</div>
</div>
<div
className={`w-element w-element-13`}>
<h3
className={`w-element w-element-18`}>
<span
className={`w-element`}>
{"Our Services"}
</span>
</h3>
<ul
className={`w-element w-element-14`}>
<li
className={`w-element`}>
{"View All Services"}
</li>
<li
className={`w-element`}>
<Link
href={"https://d2oe0ra32qx05a.cloudfront.net/?practiceKey=k_1_112536"}
className={`w-element w-element-24`}>
{"Book Appointment"}
</Link>
</li>
</ul>
</div>
<div
className={`w-element w-element-15`}>
<h3
className={`w-element w-element-19`}>
<span
className={`w-element`}>
{"Contact Info"}
</span>
</h3>
<ul
className={`w-element w-element-16`}>
<li
className={`w-element`}>
{"Home"}
</li>
<li
className={`w-element`}>
{"About"}
</li>
<li
className={`w-element`}>
{"Insurance"}
</li>
<li
className={`w-element`}>
{"Services"}
</li>
<li
className={`w-element`}>
{"Contact"}
</li>
</ul>
</div>
</div>
</Fragment_1>
</Slot>
</div>
</Body>
}

export { Page }