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{"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","192":"what_prompted_you_to_look_for_a_solution_like_ours_today","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 === 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'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 = "

" + detail + "

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'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 (FIXED Oct 21) ───────────── // Fixes: (1) phone always sent as +E.164, (2) AC errors are shown instead of // silently loading Calendly, (3) blocks duplicate submits / duplicate listeners. var WORKER_URL = 'https://cliniconex-form-proxy.gerald-48c.workers.dev/form-proxy'; function ccxPhoneE164(form) { var input = form.querySelector('#phone'); var raw = input ? String(input.value || '').trim() : ''; var digits = raw.replace(/\D/g, ''); if (!digits) return ''; if (window._iti) { try { var n = window._iti.getNumber(); if (n && n.charAt(0) === '+' && n.replace(/\D/g, '').length >= 8) { return '+' + n.replace(/\D/g, ''); } } catch (e) {} try { var d = window._iti.getSelectedCountryData(); if (d && d.dialCode) { if (raw.charAt(0) === '+') return '+' + digits; if (digits.indexOf(d.dialCode) === 0 && digits.length > 10) return '+' + digits; return '+' + d.dialCode + digits; } } catch (e) {} } if (raw.charAt(0) === '+') return '+' + digits; if (digits.length === 10) return '+1' + digits; if (digits.length === 11 && digits.charAt(0) === '1') return '+' + digits; return '+' + digits; } if (!window._ccxDemoBound) { window._ccxDemoBound = true; document.getElementById('_form_13_').addEventListener('submit', function (e) { e.preventDefault(); e.stopImmediatePropagation(); if (window._ccxDemoBusy) return; if (typeof window._ac_validate_form === 'function' && !window._ac_validate_form(e)) return; var form = document.getElementById('_form_13_'); var submitBtn = document.getElementById('_form_13_submit'); window._ccxDemoBusy = true; submitBtn.disabled = true; submitBtn.classList.add('processing'); function fail(msg) { window._ccxDemoBusy = false; window._show_error('13', msg || 'Sorry, your submission failed. Please try again.'); } grecaptcha.enterprise.ready(function () { grecaptcha.enterprise.execute('6LcrEZYsAAAAAEeGwI4HxRU-4hnrZZ8MLjCnKkd5', { action: 'SUBMIT_DEMO_FORM' }) .then(function (token) { 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); } }); var orgVal = (form.querySelector('[name="field[74]"]') || {}).value || ''; if (orgVal !== 'Medical Clinic' && orgVal !== 'Senior Care') { formData.set('field[174]', 'Not Applicable'); formData.set('field[175]', 'Not Applicable'); } var orgVal = (form.querySelector('[name="field[74]"]') || {}).value || ''; if (orgVal !== 'Medical Clinic' && orgVal !== 'Senior Care') { formData.set('field[174]', 'Not Applicable'); formData.set('field[175]', 'Not Applicable'); } var phone = ccxPhoneE164(form); if (phone) formData.append('phone', phone); formData.append('recaptcha_token', token); return fetch(WORKER_URL, { method: 'POST', body: formData }); }) .then(function (response) { if (response.status === 403) { fail('We could not verify your submission. Please try again or contact us directly.'); return null; } if (!response.ok) throw new Error('Worker returned ' + response.status); return response.text(); }) .then(function (body) { if (body === null) return; // AC replies with _show_error(...) when it rejects a submission. if (/_show_error\s*\(/.test(body || '')) { var m = body.match(/_show_error\(\s*"13"\s*,\s*"([^"]*)"/); console.error('[demo-form] AC rejected submission:', body); window.dataLayer = window.dataLayer || []; window.dataLayer.push({ event: 'demo_form_error', error_text: m ? m[1] : 'unknown' }); fail(m ? m[1] : null); return; } 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 || '' }); var emailVal = (form.querySelector('[name="email"]') || {}).value || ''; window._show_thank_you('13', '

Thanks! Loading your booking calendar…

', undefined, emailVal); }) .catch(function (err) { console.error('[demo-form]', err); fail(); }); }); }, 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 }); });

1-844-891-8492

sales@cliniconex.com