diff options
| author | Jos Poortvliet <jospoortvliet@gmail.com> | 2018-02-22 23:30:07 +0300 |
|---|---|---|
| committer | Jos Poortvliet <jos@opensuse.org> | 2018-02-27 22:31:11 +0300 |
| commit | 1f4d0c9e7fdf54eb44549c0669a50b0d3e4ff1f5 (patch) | |
| tree | e3ebac9d0687167409b561e2082a3c37ae191c5f /page-healthcare.php | |
| parent | 033907f260e65a83420376bed9f7cbee9026546e (diff) | |
finish submission form
Signed-off-by: Jos Poortvliet <jospoortvliet@gmail.com>
Diffstat (limited to 'page-healthcare.php')
| -rw-r--r-- | page-healthcare.php | 7 |
1 files changed, 6 insertions, 1 deletions
diff --git a/page-healthcare.php b/page-healthcare.php index 363a80d6..82b0d306 100644 --- a/page-healthcare.php +++ b/page-healthcare.php @@ -59,7 +59,12 @@ require(["require.config"], function() { <div id="RecaptchaField1"></div> </div> </td> - <input class="mail" type="text" name="email" maxlength="80" placeholder="Enter your email"></label> <input class="button button--large" type="submit" value=" Get the Analysis "></p> + <input type="hidden" name="segmentId" value="2"> + <input class="mail" type="text" name="email" maxlength="80" placeholder="Enter your email"></label> + <input class="button button--large" type="submit" value=" Get the Analysis "> + + + </p> </form> </div> </div> |