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    Introducing ACS Forms and ACS Surveys!

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    Case Study | Heartfelt Communication from an Interventional Cardiologist

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    Cliniconex Turned 16!

    Celebrating 16 years of communicating, collaborating, and connecting.

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Impact of Delayed Adoption of Technology

All your Cliniconex updates, senior care and medical clinic industry news and analysis in one place.

Impact of Delayed Adoption of Technology

All your Cliniconex updates, senior care and medical clinic industry news and analysis in one place.

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Check-In, Simplified

Just launched: ACS Check-in lets patients check themselves in at the kiosk, syncing straight to the EHR/EMR. See how to set it up for your team.

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Connect with us at the Paranedic Across Canada Expo in Victoria, BC! Stop by booth 29 to see how automation gives community paramedicine crews more time with patients. Let’s Connect.

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CoreQ, On Autopilot 📋

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CoreQ compliance shouldn’t cost your team a week of chart reviews and follow-up calls. Learn how ACS Surveys automates delivery, reminders, and reporting for skilled nursing facilities. Read the Article.

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Arrivals, Streamlined 📲

New: ACS Check-in turns the front-desk queue into a self-serve kiosk. Patients check themselves in, confirm their details, and pay any appointment fees in seconds. Say goodbye to line-ups and unpaid balances. See It Work.

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20px}#_form_13_._inline-style ._button-wrapper:not(._clear){margin-left:0}#_form_13_ ._form-thank-you{position:relative;left:0;right:0;text-align:center;font-size:18px}#_form_13_ ._form-pc-confirmation ._submit{margin-top:16px}@media (min-width:320px) and (max-width:667px){#_form_13_._inline-form._inline-style ._inline-style._button-wrapper{margin-top:20px !important;margin-left:0 !important}}#_form_13_ .iti{width:100%}#_form_13_ .iti.iti--allow-dropdown.iti--separate-dial-code{width:100%}#_form_13_ .iti input{width:100%;border:#979797 1px solid;border-radius:4px}#_form_13_ .iti--separate-dial-code .iti__selected-flag{background-color:#FFFFFF;border-radius:4px}#_form_13_ .iti--separate-dial-code .iti__selected-flag:hover{background-color:rgba(0, 0, 0, 0.05)}#_form_13_ .iti__country-list{border-radius:4px;margin-top:4px;min-width:460px}#_form_13_ .iti__country-list--dropup{margin-bottom:4px}#_form_13_ .phone-error-hidden{display:none}#_form_13_ .phone-error{color:#E40E49}#_form_13_ .phone-input-error{border:1px solid #E40E49 !important}#_form_13_._inline-form ._form-content ._form-list-subscriptions-field fieldset{margin:0;margin-bottom:1.1428571429em;border:none;padding:0}#_form_13_._inline-form ._form-content ._form-list-subscriptions-field fieldset:last-child{margin-bottom:0}#_form_13_._inline-form ._form-content ._form-list-subscriptions-field legend{margin-bottom:1.1428571429em}#_form_13_._inline-form ._form-content ._form-list-subscriptions-field label{display:flex;align-items:flex-start;justify-content:flex-start;margin-bottom:0.8571428571em}#_form_13_._inline-form ._form-content ._form-list-subscriptions-field label:last-child{margin-bottom:0}#_form_13_._inline-form ._form-content ._form-list-subscriptions-field input{margin:0;margin-right:8px}#_form_13_._inline-form ._form-content ._form-list-subscriptions-field ._form-checkbox-option-label{display:block;font-weight:400;margin-top:-4px}#_form_13_._inline-form ._form-content ._form-list-subscriptions-field ._form-checkbox-option-label-with-description{display:block;font-weight:700;margin-top:-4px}#_form_13_._inline-form ._form-content ._form-list-subscriptions-field ._form-checkbox-option-description{margin:0;font-size:0.8571428571em}#_form_13_._inline-form ._form-content ._form-list-subscriptions-field ._form-subscriptions-unsubscribe-all-description{line-height:normal;margin-top:-2px} /* Honeypot — keep visually hidden; bots fill it, humans never see it. */ #_form_13_ ._hp_wrap{position:absolute !important;left:-9999px !important;top:-9999px !important;height:0 !important;width:0 !important;overflow:hidden !important}

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Ambulance Services Health Plan Hospital Medical Clinic Senior Care Other
AbelMed Accuro (QHR Technologies) CHR (Telus Health) drchrono Epic ESO Eternaview Fynn.io HealthCall Healthquest (Microquest) ImageTrend Innova Health Julota MatrixCare MedAccess (Telus Health) Meditech NetSmart OSCAR (WELL Health) Person Centred Software PointClickCare Prehos PSS (Telus Health) SigmaCare (MatrixCare) WellSky Yardi YMS Other
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Senior Care | Single Facility Senior Care | 15 or Less Locations Senior Care | 16 or More Locations Hospital or Health System Medical Clinic | Single Provider Medical Clinic | 18 or Less Providers Medical Clinic | 19 or More Providers

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// ─── SECTION 1: Standard ActiveCampaign Engine ──────────────────────────────── window.cfields = {"59":"job_title_form","74":"select_your_organization_type_newsletter","129":"contact_select_your_ehremr","174":"are_you_a_current_cliniconex_customer","175":"what_is_the_size_of_your_organization","71":"how_did_you_hear_about_us","36":"im_product_interest","43":"im_themes_topics","44":"im_customer_journey","57":"im_sub-sector_interest","58":"im_sub-specialty_interest","169":"utmsourcev2_1","168":"utmcontentv2","170":"utmcampaignv2","171":"utmchannelmediumv2","172":"utmtermv2","173":"gclidv2","42":"im_painpoints_interest","176":"solution_advisor_transcript"}; window._show_thank_you = function(id, message, trackcmp_url, email) { var form = document.getElementById('_form_' + id + '_'), thank_you = form.querySelector('._form-thank-you'); form.querySelector('._form-content').style.display = 'none'; thank_you.innerHTML = message; thank_you.style.display = 'block'; const vgoAlias = typeof visitorGlobalObjectAlias === 'undefined' ? 'vgo' : visitorGlobalObjectAlias; var visitorObject = window[vgoAlias]; if (email && typeof visitorObject !== 'undefined') { visitorObject('setEmail', email); visitorObject('update'); } else if (typeof(trackcmp_url) != 'undefined' && trackcmp_url) { _load_script(trackcmp_url); } if (typeof window._form_callback !== 'undefined') window._form_callback(id); thank_you.setAttribute('tabindex', '-1'); thank_you.focus(); }; window._show_unsubscribe = function(id, message, trackcmp_url, email) { var form = document.getElementById('_form_' + id + '_'), unsub = form.querySelector('._form-thank-you'); var branding = form.querySelector('._form-branding'); if (branding) { branding.style.display = 'none'; } form.querySelector('._form-content').style.display = 'none'; unsub.style.display = 'block'; form.insertAdjacentHTML('afterend', message); const vgoAlias = typeof visitorGlobalObjectAlias === 'undefined' ? 'vgo' : visitorGlobalObjectAlias; var visitorObject = window[vgoAlias]; if (email && typeof visitorObject !== 'undefined') { visitorObject('setEmail', email); visitorObject('update'); } else if (typeof(trackcmp_url) != 'undefined' && trackcmp_url) { _load_script(trackcmp_url); } if (typeof window._form_callback !== 'undefined') window._form_callback(id); }; window._show_error = function(id, message, html) { var form = document.getElementById('_form_' + id + '_'), err = document.createElement('div'), button = form.querySelector('button[type="submit"]'), old_error = form.querySelector('._form_error'); if (old_error) old_error.parentNode.removeChild(old_error); err.innerHTML = message; err.className = '_error-inner _form_error _no_arrow'; var wrapper = document.createElement('div'); wrapper.className = '_form-inner _show_be_error'; wrapper.appendChild(err); button.parentNode.insertBefore(wrapper, button); var submitButton = form.querySelector('[id^="_form"][id$="_submit"]'); submitButton.disabled = false; submitButton.classList.remove('processing'); if (html) { var div = document.createElement('div'); div.className = '_error-html'; div.innerHTML = html; err.appendChild(div); } }; window._show_pc_confirmation = function(id, header, detail, show, email) { var form = document.getElementById('_form_' + id + '_'), pc_confirmation = form.querySelector('._form-pc-confirmation'); if (pc_confirmation.style.display === 'none') { form.querySelector('._form-content').style.display = 'none'; pc_confirmation.innerHTML = "
" + header + "

" + detail + "

"; pc_confirmation.style.display = 'block'; document.querySelector('input[name="mp"]').value = '0'; } else { form.querySelector('._form-content').style.display = 'inline'; pc_confirmation.style.display = 'none'; } document.getElementById('hideButton').addEventListener('click', function() { var submitButton = document.querySelector('#_form_13_submit'); submitButton.disabled = false; submitButton.classList.remove('processing'); document.querySelector('input[name="mp"]').value = '1'; const cacheBuster = new URL(window.location.href); cacheBuster.searchParams.set('v', new Date().getTime()); window.location.href = cacheBuster.toString(); }); const vgoAlias = typeof visitorGlobalObjectAlias === 'undefined' ? 'vgo' : visitorGlobalObjectAlias; var visitorObject = window[vgoAlias]; if (email && typeof visitorObject !== 'undefined') { visitorObject('setEmail', email); visitorObject('update'); } else if (typeof(trackcmp_url) != 'undefined' && trackcmp_url) { _load_script(trackcmp_url); } if (typeof window._form_callback !== 'undefined') window._form_callback(id); }; window._load_script = function(url, callback, isSubmit) { var head = document.querySelector('head'), script = document.createElement('script'), r = false; var submitButton = document.querySelector('#_form_13_submit'); script.charset = 'utf-8'; script.src = url; if (callback) { script.onload = script.onreadystatechange = function() { if (!r && (!this.readyState || this.readyState == 'complete')) { r = true; callback(); } }; } script.onerror = function() { if (isSubmit) { if (script.src.length > 10000) { _show_error("13", "Sorry, your submission failed. Please shorten your responses and try again."); } else { _show_error("13", "Sorry, your submission failed. Please try again."); } submitButton.disabled = false; submitButton.classList.remove('processing'); } }; head.appendChild(script); }; (function() { var iti; if (window.location.search.search("excludeform") !== -1) return false; var getCookie = function(name) { var match = document.cookie.match(new RegExp('(^|; )' + name + '=([^;]+)')); return match ? match[2] : localStorage.getItem(name); } var setCookie = function(name, value) { var now = new Date(); var time = now.getTime(); var expireTime = time + 1000 * 60 * 60 * 24 * 365; now.setTime(expireTime); document.cookie = name + '=' + value + '; expires=' + now + ';path=/; Secure; SameSite=Lax;'; localStorage.setItem(name, value); } var addEvent = function(element, event, func) { if (element.addEventListener) { element.addEventListener(event, func); } else { var oldFunc = element['on' + event]; element['on' + event] = function() { oldFunc.apply(this, arguments); func.apply(this, arguments); }; } } var _removed = false; var form_to_submit = document.getElementById('_form_13_'); var allInputs = form_to_submit.querySelectorAll('input, select, textarea'), tooltips = [], submitted = false; var getUrlParam = function(name) { if (name.toLowerCase() !== 'email') { var params = new URLSearchParams(window.location.search); return params.get(name) || false; } var qString = window.location.search; if (!qString) { return false; } var parameters = qString.substr(1).split('&'); for (var i = 0; i < parameters.length; i++) { var parameter = parameters[i].split('='); if (parameter[0].toLowerCase() === 'email') { return parameter[1] === undefined ? true : decodeURIComponent(parameter[1]); } } return false; }; var acctDateFormat = "%d/%m/%Y"; var getNormalizedDate = function(date, acctFormat) { var decodedDate = decodeURIComponent(date); if (acctFormat && acctFormat.match(/(%d|%e).*%m/gi) !== null) { return decodedDate.replace(/(\d{2}).*(\d{2}).*(\d{4})/g, '$3-$2-$1'); } else if (Date.parse(decodedDate)) { var dateObj = new Date(decodedDate); var year = dateObj.getFullYear(); var month = dateObj.getMonth() + 1; var day = dateObj.getDate(); return `${year}-${month < 10 ? `0${month}` : month}-${day < 10 ? `0${day}` : day}`; } return false; }; var getNormalizedTime = function(time) { var hour, minutes; var decodedTime = decodeURIComponent(time); var timeParts = Array.from(decodedTime.matchAll(/(\d{1,2}):(\d{1,2})\W*([AaPp][Mm])?/gm))[0]; if (timeParts[3]) { var isPM = timeParts[3].toLowerCase() === 'pm'; if (isPM) { hour = parseInt(timeParts[1]) === 12 ? '12' : `${parseInt(timeParts[1]) + 12}`; } else { hour = parseInt(timeParts[1]) === 12 ? '0' : timeParts[1]; } } else { hour = timeParts[1]; } var normalizedHour = parseInt(hour) < 10 ? `0${parseInt(hour)}` : hour; minutes = timeParts[2]; return `${normalizedHour}:${minutes}`; }; for (var i = 0; i < allInputs.length; i++) { var regexStr = "field\\[(\\d+)\\]"; var results = new RegExp(regexStr).exec(allInputs[i].name); if (results != undefined) { allInputs[i].dataset.name = allInputs[i].name.match(/\[time\]$/) ? `${window.cfields[results[1]]}_time` : window.cfields[results[1]]; } else { allInputs[i].dataset.name = allInputs[i].name; } var fieldVal = getUrlParam(allInputs[i].dataset.name); if (fieldVal) { if (allInputs[i].dataset.autofill === "false") { continue; } if (allInputs[i].type == "radio" || allInputs[i].type == "checkbox") { if (allInputs[i].value == fieldVal) { allInputs[i].checked = true; } } else if (allInputs[i].type == "date") { allInputs[i].value = getNormalizedDate(fieldVal, acctDateFormat); } else if (allInputs[i].type == "time") { allInputs[i].value = getNormalizedTime(fieldVal); } else { allInputs[i].value = fieldVal; } } } var remove_tooltips = function() { for (var i = 0; i < tooltips.length; i++) { tooltips[i].tip.parentNode.removeChild(tooltips[i].tip); } tooltips = []; }; var remove_tooltip = function(elem) { for (var i = 0; i < tooltips.length; i++) { if (tooltips[i].elem === elem) { tooltips[i].tip.parentNode.removeChild(tooltips[i].tip); tooltips.splice(i, 1); return; } } }; var create_tooltip = function(elem, text) { var tooltip = document.createElement('div'), arrow = document.createElement('div'), inner = document.createElement('div'), new_tooltip = {}; tooltip.id = `${elem.id}-error`; tooltip.setAttribute('role', 'alert'); if (elem.type != 'radio' && (elem.type != 'checkbox' || elem.name === 'sms_consent')) { tooltip.className = '_error'; arrow.className = '_error-arrow'; inner.className = '_error-inner'; inner.innerHTML = text; tooltip.appendChild(arrow); tooltip.appendChild(inner); elem.parentNode.appendChild(tooltip); } else { tooltip.className = '_error-inner _no_arrow'; tooltip.innerHTML = text; elem.parentNode.insertBefore(tooltip, elem); new_tooltip.no_arrow = true; } new_tooltip.tip = tooltip; new_tooltip.elem = elem; tooltips.push(new_tooltip); return new_tooltip; }; var resize_tooltip = function(tooltip) { var rect = tooltip.elem.getBoundingClientRect(); var doc = document.documentElement, scrollPosition = rect.top - ((window.pageYOffset || doc.scrollTop) - (doc.clientTop || 0)); if (scrollPosition < 40) { tooltip.tip.className = tooltip.tip.className.replace(/ ?(_above|_below) ?/g, '') + ' _below'; } else { tooltip.tip.className = tooltip.tip.className.replace(/ ?(_above|_below) ?/g, '') + ' _above'; } }; var resize_tooltips = function() { if (_removed) return; for (var i = 0; i < tooltips.length; i++) { if (!tooltips[i].no_arrow) resize_tooltip(tooltips[i]); } }; var validate_field = function(elem, remove) { var tooltip = null, value = elem.value, no_error = true; remove ? remove_tooltip(elem) : false; elem.removeAttribute('aria-invalid'); elem.removeAttribute('aria-describedby'); if (elem.type != 'checkbox') elem.className = elem.className.replace(/ ?_has_error ?/g, ''); if (elem.getAttribute('required') !== null) { if (elem.type == 'radio' || (elem.type == 'checkbox' && /any/.test(elem.className))) { var elems = form_to_submit.elements[elem.name]; if (!(elems instanceof NodeList || elems instanceof HTMLCollection) || elems.length <= 1) { no_error = elem.checked; } else { no_error = false; for (var i = 0; i < elems.length; i++) { if (elems[i].checked) no_error = true; } } if (!no_error) { tooltip = create_tooltip(elem, "Please select an option."); } } else if (elem.type == 'checkbox') { var elems = form_to_submit.elements[elem.name], found = false, err = []; no_error = true; for (var i = 0; i < elems.length; i++) { if (elems[i].getAttribute('required') === null) continue; if (!found && elems[i] !== elem) return true; found = true; elems[i].className = elems[i].className.replace(/ ?_has_error ?/g, ''); if (!elems[i].checked) { no_error = false; elems[i].className = elems[i].className + ' _has_error'; err.push("Checking %s is required".replace("%s", elems[i].value)); } } if (!no_error) { tooltip = create_tooltip(elem, err.join('
')); } } else if (elem.tagName == 'SELECT') { var selected = true; if (elem.multiple) { selected = false; for (var i = 0; i < elem.options.length; i++) { if (elem.options[i].selected) { selected = true; break; } } } else { for (var i = 0; i 0; const showError = (consentRequired || !!elem.attributes.required) && !elem.checked; if (showError) { elem.className = elem.className + ' _has_error'; no_error = false; tooltip = create_tooltip(elem, "Please check this box to continue"); } else { elem.className = elem.className.replace(/ ?_has_error ?/g, ''); } } tooltip ? resize_tooltip(tooltip) : false; if (!no_error && elem.hasAttribute('id')) { elem.setAttribute('aria-invalid', 'true'); elem.setAttribute('aria-describedby', `${elem.id}-error`); } return no_error; }; var needs_validate = function(el) { if (el.getAttribute('required') !== null) { return true; } if ((el.name === 'email' || el.id === 'phone' || el.id === 'sms_consent') && el.value !== "") { return true; } return false; }; // Expose validate_form for Section 4 window._ac_validate_form = function(e) { var err = form_to_submit.querySelector('._form_error'), no_error = true; if (!submitted) { submitted = true; for (var i = 0, len = allInputs.length; i < len; i++) { var input = allInputs[i]; if (needs_validate(input)) { if (input.type == 'text' || input.type == 'number' || input.type == 'time' || input.type == 'tel') { addEvent(input, 'blur', function() { this.value = this.value.trim(); validate_field(this, true); }); addEvent(input, 'input', function() { validate_field(this, true); }); } else if (input.type == 'radio' || input.type == 'checkbox') { (function(el) { function getElementsArray(name){ const value = form_to_submit.elements[name]; if (Array.isArray(value)){ return value; } return [value]; } var radios = getElementsArray(el.name); for (var i = 0; i < radios.length; i++) { addEvent(radios[i], 'change', function() { validate_field(el, true); }); } })(input); } else if (input.tagName == 'SELECT') { addEvent(input, 'change', function() { validate_field(this, true); }); } else if (input.type == 'textarea') { addEvent(input, 'input', function() { validate_field(this, true); }); } } } } remove_tooltips(); for (var i = 0, len = allInputs.length; i import('https://cdn.jsdelivr.net/npm/intl-tel-input@25.2.0/build/js/utils.js'), hiddenInput: (telInputName) => ({ phone: 'phone' }), separateDialCode: true, autoPlaceholder: 'aggressive', initialCountry: 'auto', geoIpLookup: (success) => { fetch('https://cliniconexmarketing.activehosted.com/api/public/geo.php') .then((res) => res.json()) .then((data) => success(data.country_code || 'US')) .catch(() => success('US')); } }); window._iti = iti; // expose globally for Section 4 }, false); }; var inputPhone = form_to_submit.querySelector("#phone"); if (inputPhone) { initializePhoneInput(inputPhone); } // Expose _form_serialize for Section 4 window._ac_form_serialize = function(form){if(!form||form.nodeName!=="FORM"){return }var i,j,q=[];for(i=0;i auto-select "Other" } } function rebuildSize(org) { var current = sizeEl.value; sizeEl.innerHTML = ''; allSizeOpts.forEach(function (o) { if (o.value === "" || o.value.indexOf(org) === 0) { // blank + sizes whose value starts with this org var opt = document.createElement("option"); opt.value = o.value; opt.textContent = o.text; sizeEl.appendChild(opt); } }); sizeEl.value = Array.prototype.some.call(sizeEl.options, function (o) { return o.value === current && current !== ""; }) ? current : ""; } function normalize() { var org = orgSelect.value; var needsRouting = (org === "Medical Clinic" || org === "Senior Care"); // Status + size start hidden; revealed only for Medical Clinic / Senior Care. statusWrapper.style.display = needsRouting ? "block" : "none"; sizeWrapper.style.display = needsRouting ? "block" : "none"; if (needsRouting) { statusEl.setAttribute("required", "required"); sizeEl.setAttribute("required", "required"); } else { // not routed: clear required + value so a hidden field can never block submit statusEl.removeAttribute("required"); sizeEl.removeAttribute("required"); statusEl.value = ""; sizeEl.value = ""; } rebuildSize(org); if (org) { rebuildEmr(org); } // leave the full EMR list until an org type is chosen } orgSelect.addEventListener("change", normalize); // Run once on load: a blank form starts with status + size hidden; a UTM/URL // pre-filled org type reveals and filters them correctly. normalize(); function getTargetCalendly() { var org = orgSelect.value; var isCustomer = (statusEl.value === "Yes"); var size = sizeEl.value; if (org === "Hospital") { return "https://calendly.com/cliniconexsales/automated-care-platform-demo-hospital"; } if (org === "Other" || org === "Health Plan") { return "https://calendly.com/chukwudi-cliniconex/30-minute-meeting"; } if (size === "Medical Clinic | Single Provider") { return isCustomer ? "https://calendly.com/cliniconexsales/acp-medical" : "https://calendly.com/cliniconexsales/acp-medical-direct"; } if (size === "Medical Clinic | 18 or Less Providers") { return isCustomer ? "https://calendly.com/cliniconexsales/acp-medical" : "https://calendly.com/cliniconexsales/acp-medical-direct"; } if (size === "Medical Clinic | 19 or More Providers") { return isCustomer ? "https://calendly.com/cliniconexsales/acp-expansion-medical" : "https://calendly.com/cliniconexsales/automated-care-platform-demo-enterprise-medical"; } if (size === "Senior Care | Single Facility") { return isCustomer ? "https://calendly.com/cliniconexsales/acp-senior" : "https://calendly.com/cliniconexsales/acp-senior-direct"; } if (size === "Senior Care | 15 or Less Locations") { return isCustomer ? "https://calendly.com/cliniconexsales/acp-senior" : "https://calendly.com/cliniconexsales/acp-senior-direct"; } if (size === "Senior Care | 16 or More Locations") { return isCustomer ? "https://calendly.com/cliniconexsales/acp-expansion-senior" : "https://calendly.com/cliniconexsales/automated-care-platform-demo-enterprise-senior"; } return "https://calendly.com/cliniconexsales/automated-care-platform-demo-hospital"; } setTimeout(function () { var originalThankYou = window._show_thank_you; window._show_thank_you = function (id, message, trackcmp_url, email) { if (originalThankYou) { originalThankYou(id, message, trackcmp_url, email); } var fname = (formEl.querySelector('[name="firstname"]') || {}).value || ""; var lname = (formEl.querySelector('[name="lastname"]') || {}).value || ""; var phone = (formEl.querySelector('[name="phone"]') || {}).value || ""; var baseUrl = getTargetCalendly(); var embedUrl = baseUrl + "?name=" + encodeURIComponent(fname + " " + lname) + "&email=" + encodeURIComponent(email) + "&a2=" + encodeURIComponent(phone); setTimeout(function () { var container = document.getElementById("cliniconex-calendly-container"); formEl.style.display = "none"; if (container) { container.style.display = "block"; container.innerHTML = '
'; if (window.Calendly && window.Calendly.initInlineWidget) { window.Calendly.initInlineWidget({ url: embedUrl, parentElement: container.querySelector('.calendly-inline-widget') }); } } }, 100); }; }, 500); }); // ─── SECTION 3: Honeypot check ─────────────────────────────────────────────── document.getElementById('_form_13_').addEventListener('submit', function (e) { var honeypot = document.getElementById('website_url_hp'); if (honeypot && honeypot.value !== '') { e.preventDefault(); e.stopImmediatePropagation(); return false; } }, true); // ─── SECTION 4: reCAPTCHA Enterprise v3 intercept ──────────────────────────── var WORKER_URL = 'https://cliniconex-form-proxy.gerald-48c.workers.dev/form-proxy'; document.getElementById('_form_13_').addEventListener('submit', async function (e) { e.preventDefault(); e.stopImmediatePropagation(); if (typeof window._ac_validate_form === 'function' && !window._ac_validate_form(e)) { return; } var submitBtn = document.getElementById('_form_13_submit'); var form = document.getElementById('_form_13_'); submitBtn.disabled = true; submitBtn.classList.add('processing'); try { // 1. Get reCAPTCHA Enterprise token await new Promise(function(resolve) { grecaptcha.enterprise.ready(resolve); }); var token = await grecaptcha.enterprise.execute( '6LcrEZYsAAAAAEeGwI4HxRU-4hnrZZ8MLjCnKkd5', { action: 'SUBMIT_DEMO_FORM' } ); // 2. Get clean E.164 phone number via window._iti (exposed globally from Section 1) var phoneNumber = ''; if (typeof window._iti !== 'undefined') { phoneNumber = window._iti.getNumber(); // returns +16134567891 } // 3. Serialize form — exclude phone fields, we add manually below var serialized = window._ac_form_serialize(form).replace(/%0A/g, '\\n'); var formData = new FormData(); new URLSearchParams(serialized).forEach(function(value, key) { if (key !== 'hideButton' && key !== 'phone' && key !== 'phone-iti') { formData.append(key, value); } }); // 4. Add phone in clean E.164 format — strip dashes, spaces, brackets if (phoneNumber) { var cleanPhone = phoneNumber.replace(/[\s\-\(\)]/g, ''); formData.append('phone', cleanPhone); } else { // Fallback: read directly from input and strip formatting var rawPhone = form.querySelector('input[name="phone-iti"]') || form.querySelector('input[name="phone"]'); if (rawPhone && rawPhone.value) { formData.append('phone', rawPhone.value.replace(/[\s\-\(\)]/g, '')); } } // 5. Append reCAPTCHA token formData.append('recaptcha_token', token); // 6. POST to Cloudflare Worker var response = await fetch(WORKER_URL, { method: 'POST', body: formData }); if (response.status === 403) { window._show_error('13', 'We could not verify your submission. Please try again or contact us directly.'); return; } if (!response.ok) { throw new Error('Worker returned ' + response.status); } // 7. Push GA4 event — demo_form_submitted window.dataLayer = window.dataLayer || []; window.dataLayer.push({ event: 'demo_form_submitted', form_id: 13, org_type: (form.querySelector('[name="field[74]"]') || {}).value || '', customer_status: (form.querySelector('[name="field[174]"]') || {}).value || '', org_size: (form.querySelector('[name="field[175]"]') || {}).value || '' }); // 8. Success — trigger AC thank-you + Calendly routing var emailVal = (form.querySelector('[name="email"]') || {}).value || ''; window._show_thank_you('13', '
Thanks! Loading your booking calendar…
', undefined, emailVal); } catch (err) { console.error('[recaptcha-proxy]', err); window._show_error('13', 'Sorry, your submission failed. Please try again.'); } }, true); // ─── SECTION 5: GA4 Funnel Tracking ────────────────────────────────────────── window.addEventListener('message', function (e) { if (e.origin !== 'https://calendly.com') return; if (!e.data || !e.data.event) return; if (e.data.event === 'calendly.event_scheduled') { window.dataLayer = window.dataLayer || []; window.dataLayer.push({ event: 'calendly_booked', calendly_event_uri: e.data.payload && e.data.payload.event ? e.data.payload.event.uri : undefined, calendly_invitee_uri: e.data.payload && e.data.payload.invitee ? e.data.payload.invitee.uri : undefined }); } }); document.addEventListener('click', function (e) { var trigger = e.target.closest( '[data-demo-trigger], .book-demo-btn, .demo-cta, .demov2, .off_canvas, .button-5, #menu-item-18408, .open-demo-off-canvas, a[href*="#demo"], a[href*="book-demo"]' ); if (!trigger) return; window.dataLayer = window.dataLayer || []; window.dataLayer.push({ event: 'demo_form_opened', trigger_text: (trigger.textContent || '').trim().slice(0, 50), trigger_href: trigger.getAttribute('href') || '', page_path: window.location.pathname }); });
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