File: /home/theadvocacyservicecenter/public_html/index.php
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<head>
<meta charset="utf-8">
<meta content="width=device-width, initial-scale=1.0" name="viewport">
<title>The Advocacy Service Center</title>
<meta name="description" content="">
<meta name="keywords" content="">
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<!-- Main CSS File -->
<link href="assets/css/main.css" rel="stylesheet">
<style>
ul {
list-style-type: none;
}
.med-grid {
display: grid;
grid-template-columns: repeat(4, 1fr);
gap: 10px 30px;
font-size: 14px;
}
.med-grid div {
white-space: nowrap;
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.pricing .pricing-card .features-list li i {
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margin-right: 0.75rem;
font-size: 1.25rem;
display: flex;
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margin-bottom: 0.5rem;
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/* 4-column layout */
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.features-list.med-grid {
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.features-list.med-grid {
grid-template-columns: 1fr;
}
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</style>
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</head>
<body class="index-page">
<header id="header" class="header d-flex align-items-center fixed-top">
<div class="header-container container-fluid container-xl position-relative d-flex align-items-center justify-content-between">
<a href="/" class="logo d-flex align-items-center me-auto me-xl-0">
<!-- Uncomment the line below if you also wish to use an image logo -->
<!-- <img src="assets/img/logo.png" alt=""> -->
<img class="d-block img-fluid mx-auto" src="assets/img/logo.svg" alt="Bootstrap" width="256" height="204">
</a>
<nav id="navmenu" class="navmenu">
<ul>
<li><a href="#hero" class="active">Home</a></li>
<li><a href="#mission">Mission</a></li>
<li><a href="#medical">Medical</a></li>
<li><a href="#medication">Medication</a></li>
<li><a href="#testimonials">Testimonials</a></li>
<li><a href="#contact">Contact</a></li>
</ul>
<i class="mobile-nav-toggle d-xl-none bi bi-list"></i>
</nav>
<a class="btn-getstarted" href="#referral-partners">Referral Partners</a>
<a class="btn-getstarted" href="Tel:+18882998146">Call: +1 (888) 299-8146</a>
</div>
</header>
<main class="main">
<!-- Hero Section -->
<section id="hero" class="hero section">
<div class="container" data-aos="fade-up" data-aos-delay="100">
<div class="row align-items-center">
<div class="col-lg-6">
<div class="hero-content" data-aos="fade-up" data-aos-delay="200">
<div class="company-badge mb-4">
Working for your success
</div>
<h1 class="mb-4">
Our mission is to eliminate anxiety <br>
<span class="accent-text">over bills.</span>
</h1>
<p class="mb-4 mb-md-5">
We offer assistance programs that help reduce medical costs for individuals needing financial support. These programs are available to those facing financial challenges in accessing necessary care. Administered by state governments and non-profit organizations, they ensure access to care without the financial burden. Let us guide you in finding a solution that suits your needs and budget. </p>
<div class="hero-buttons">
<a href="#contact" class="btn btn-primary me-0 me-sm-2 mx-1">Get Started</a>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="hero-image" data-aos="zoom-out" data-aos-delay="300">
<img src="assets/img/illustration-1.webp" alt="Hero Image" class="img-fluid">
</div>
</div>
</div>
</div>
</section><!-- /Hero Section -->
<!-- About Section -->
<section id="mission" class="about section">
<div class="container" data-aos="fade-up" data-aos-delay="100">
<div class="row gy-4 align-items-center justify-content-between">
<div class="col-xl-5" data-aos="fade-up" data-aos-delay="200">
<span class="about-meta">OUR MISSION </span>
<h2 class="about-title">Our Mission Is To Eradicate The Anxiety Associated With Medical Bills.</h2>
<p class="about-description">
Financial assistance programs, often referred to as "charity care," offer cost-free
or reduced-cost healthcare services to individuals requiring financial assistance to
cover their medical expenses. Such programs can benefit both uninsured patients and
those with insurance but facing inadequate coverage. These initiatives can be administered
by your healthcare provider or your state government. Moreover, non-profit organizations
and advocacy groups may also extend their support in these situations.
</p>
<div class="row feature-list-wrapper">
<div class="col-md-6">
<ul class="feature-list">
<li><i class="bi bi-check-circle-fill"></i> Hospital programs</li>
<li><i class="bi bi-check-circle-fill"></i> Income-based</li>
<li><i class="bi bi-check-circle-fill"></i> Bill Reduction</li>
</ul>
</div>
<div class="col-md-6">
<ul class="feature-list">
<li><i class="bi bi-check-circle-fill"></i> Prescription Help</li>
<li><i class="bi bi-check-circle-fill"></i> State Aid</li>
<li><i class="bi bi-check-circle-fill"></i> Nonprofit Support</li>
</ul>
</div>
</div>
<div class="info-wrapper">
<div class="row gy-4">
<div class="col-lg-2">
<div class="profile d-flex align-items-center gap-3">
<img src="assets/img/avatar-1.webp" alt="CEO Profile" class="profile-image">
</div>
</div>
<div class="col-lg-9">
<div class="contact-info d-flex align-items-center gap-2">
<i class="bi bi-telephone-fill"></i>
<div>
<p class="contact-label">Call us anytime</p>
<p class="contact-number"><a href="Tel:18882998146">+1 (888) 299-8146</a></p>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="col-xl-6" data-aos="fade-up" data-aos-delay="300">
<div class="image-wrapper">
<div class="images position-relative" data-aos="zoom-out" data-aos-delay="400">
<img src="assets/img/about-5.webp" alt="Business Meeting" class="img-fluid main-image rounded-4">
<img src="assets/img/about-2.webp" alt="Team Discussion" class="img-fluid small-image rounded-4">
</div>
<div class="experience-badge floating">
<h3>30+ <span>Years</span></h3>
<p>combined experience in business service</p>
</div>
</div>
</div>
</div>
</div>
</section><!-- /About Section -->
<!-- Stats Section -->
<section id="medical" class="stats section">
<div class="container" data-aos="fade-up" data-aos-delay="100">
<div class="row gy-4 text-center">
<h2 style="font-weight:bold;">Important Medical Cost Facts</h2>
<p>Understanding these critical numbers can help you make smarter decisions <br>about your healthcare and coverage options.</p>
<div class="col-lg-3 col-md-6">
<div class="stats-item text-center w-100 h-100 flex-wrap: nowrap;">
<span data-purecounter-start="0" data-purecounter-end="25" data-purecounter-suffix="%" data-purecounter-duration="1" class="purecounter"></span>
<p>25.3 million people in the U.S. were uninsured in 2023.</p>
</div>
</div><!-- End Stats Item -->
<div class="col-lg-3 col-md-6">
<div class="stats-item text-center w-100 h-100">
<span data-purecounter-start="0" data-purecounter-end="30" data-purecounter-duration="1" class="purecounter"></span>
<p>30+ years of combined experience as patient advocates.</p>
</div>
</div><!-- End Stats Item -->
<div class="col-lg-3 col-md-6">
<div class="stats-item text-center w-100 h-100">
<span data-purecounter-start="0" data-purecounter-end="38" data-purecounter-duration="1" class="purecounter"></span>
<p>38+ years of combined medical experience.</p>
</div>
</div><!-- End Stats Item -->
<div class="col-lg-3 col-md-6">
<div class="stats-item text-center w-100 h-100">
<span data-purecounter-start="0" data-purecounter-end="18660" data-purecounter-duration="1" class="purecounter"></span>
<p>$18,660 is the average medical debt per person in the U.S. (2021).</p>
</div>
</div><!-- End Stats Item -->
<div class="col-lg-3 col-md-6">
<div class="stats-item text-center w-100 h-100">
<span data-purecounter-start="0" data-purecounter-end="25" data-purecounter-duration="1" class="purecounter"></span>
<p>25% of prescription drugs were not covered by insurance in 2024.</p>
</div>
</div><!-- End Stats Item -->
<div class="col-lg-3 col-md-6">
<div class="stats-item text-center w-100 h-100">
<span data-purecounter-start="0" data-purecounter-end="6604" data-purecounter-duration="1" class="purecounter"></span>
<p>$6,604 is the average annual cost for brand-name drugs.</p>
</div>
</div><!-- End Stats Item -->
<div class="col-lg-3 col-md-6">
<div class="stats-item text-center w-100 h-100">
<span data-purecounter-start="0" data-purecounter-end="85" data-purecounter-duration="1" class="purecounter"></span>
<p>85% of ER and hospital services are billed out-of-network.</p>
</div>
</div><!-- End Stats Item -->
<div class="col-lg-3 col-md-6">
<div class="stats-item text-center w-100 h-100">
<span data-purecounter-start="0" data-purecounter-end="95" data-purecounter-duration="1" class="purecounter"></span>
<p>95% patient satisfaction rating across all services provided.</p>
</div>
</div><!-- End Stats Item -->
</div>
</div>
</section><!-- /Stats Section -->
<!-- Pricing Section -->
<section id="medication" class="pricing section light-background">
<!-- Section Title -->
<div class="container section-title" data-aos="fade-up" style="padding-bottom: 10px !important;">
<h2>Medications</h2>
<p>Here are some of the most common meds we have programs for. Most can be free with or without insurance. <br>With insurance the might cost from $0 - $35 depending on the medication</p>
</div><!-- End Section Title -->
<div class="container" data-aos="fade-up" data-aos-delay="100">
<div class="row g-4 justify-content-center">
<!-- Basic Plan -->
<div class="col-lg-12 text-center" data-aos="fade-up" data-aos-delay="100">
<div class="pricing-card">
<div class="row g-4 justify-content-center">
<div id="medications" class="features-list med-grid">
Loading medications...
</div>
</div>
</div>
</div>
</div>
</div>
</section><!-- /Pricing Section -->
<!-- Call To Action Section -->
<section id="call-to-action" class="call-to-action section">
<div class="container" data-aos="fade-up" data-aos-delay="100">
<div class="row content justify-content-center align-items-center position-relative">
<div class="col-lg-8 mx-auto text-center">
<h2>Disclaimer</h2>
<p>"The Advocacy Service Center, LLC (ASC) provides one-on-one assistance with a professional advocate to help qualified patience, their families and caregivers resolve healthcare access, and issues that may be the result of a patient being uninsured. In order to qualify for the advocacy assistance program, the patient must meet the yearly income limit, provide ID, proof of address, income and proof of insurance (if applicable).</p>
<p> ASC provides assistance with resolving a broad variety of patient and caregiver concerns including:</p>
<ul class="features-list text-center">
<li><i class="bi bi-check-circle-fill"></i> Access to Care</li>
<li><i class="bi bi-check-circle-fill"></i> Cost of Care</li>
<li><i class="bi bi-check-circle-fill"></i> Cost of Medication</li>
</ul>
<p> ASC identifies sources of assistance, including other charitable organizations and government-sponsored programs, and assist patients in enrolling in these services as appropriate. Qualifying patients are provided one-on-one service by ASC until their access to care, cost of care, Rx medication cost-related issues are resolved and there after to help you keep the service. ASC DOES NOT OFFER MEDICAL INSURANCE , NOR DISPENSE MEDICATIONS!
</p>
<a href="#contact" class="btn btn-cta">Get Started</a>
</div>
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<div class="shape shape-1">
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</div>
</section>
<!-- Testimonials Section -->
<section id="testimonials" class="testimonials section light-background">
<!-- Section Title -->
<div class="container section-title" data-aos="fade-up">
<h2>Testimonials</h2>
<p>Hear what real people are saying about their experience with us.
</p>
</div><!-- End Section Title -->
<div class="container">
<div class="row g-5">
<div class="col-lg-6" data-aos="fade-up" data-aos-delay="100">
<div class="testimonial-item">
<img src="assets/img/testimonials/testimonials-1.jpg" class="testimonial-img" alt="">
<h3>Saul Goodman</h3>
<h4>Customer</h4>
<div class="stars">
<i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i>
</div>
<p>
<i class="bi bi-quote quote-icon-left"></i>
<span>"I want to thank you again for your help. I appreciate everything you’ve done in regards to getting my Ozempic to me for an affordable price!"</span>
<i class="bi bi-quote quote-icon-right"></i>
</p>
</div>
</div><!-- End testimonial item -->
<div class="col-lg-6" data-aos="fade-up" data-aos-delay="200">
<div class="testimonial-item">
<img src="assets/img/testimonials/testimonials-2.jpg" class="testimonial-img" alt="">
<h3>M.Gauer</h3>
<h4>Customer</h4>
<div class="stars">
<i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i>
</div>
<p>
<i class="bi bi-quote quote-icon-left"></i>
<span>"I wanted to let you know that I was approved for a year supply of Xeralto... THANK YOU so much for your help with this!!!!</span>
<i class="bi bi-quote quote-icon-right"></i>
</p>
</div>
</div><!-- End testimonial item -->
<div class="col-lg-6" data-aos="fade-up" data-aos-delay="300">
<div class="testimonial-item">
<img src="assets/img/testimonials/testimonials-3.jpg" class="testimonial-img" alt="">
<h3>Jena Karlis</h3>
<h4>Customer</h4>
<div class="stars">
<i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i>
</div>
<p>
<i class="bi bi-quote quote-icon-left"></i>
<span>״The Advocacy Service Center provides top-notch service with a compassionate approach. I have always felt valued and supported.״</span>
<i class="bi bi-quote quote-icon-right"></i>
</p>
</div>
</div><!-- End testimonial item -->
<div class="col-lg-6" data-aos="fade-up" data-aos-delay="400">
<div class="testimonial-item">
<img src="assets/img/testimonials/testimonials-4.jpg" class="testimonial-img" alt="">
<h3>J. Martinez</h3>
<h4>Customer</h4>
<div class="stars">
<i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i><i class="bi bi-star-fill"></i>
</div>
<p>
<i class="bi bi-quote quote-icon-left"></i>
<span>I was overwhelmed with medical bills, but The Advocacy Service Center guided me every step of the way. Their support truly changed my life.</span>
<i class="bi bi-quote quote-icon-right"></i>
</p>
</div>
</div><!-- End testimonial item -->
</div>
</div>
</section><!-- /Testimonials Section -->
<!-- Contact Section -->
<section id="contact" class="contact section light-background">
<!-- Section Title -->
<div class="container section-title" data-aos="fade-up">
<h2>Contact</h2>
<p>We’re just a call or message away—let us help you find the support you need.</p>
</div><!-- End Section Title -->
<div class="container" data-aos="fade-up" data-aos-delay="100">
<div class="row g-4 g-lg-5">
<div class="col-lg-5">
<div class="info-box" data-aos="fade-up" data-aos-delay="200">
<h3>Contact Info</h3>
<p>We’re just a call or message away—let us help you find the support you need.</p>
<div class="info-item" data-aos="fade-up" data-aos-delay="300">
<div class="icon-box">
<i class="bi bi-geo-alt"></i>
</div>
<div class="content">
<h4>Our Location</h4>
<p>2505 NW Boca Raton Blvd.</p>
<p><b>First Floor Suite 103</b></p>
<p>Boca Raton, FL 33431</p>
</div>
</div>
<div class="info-item" data-aos="fade-up" data-aos-delay="400">
<div class="icon-box">
<i class="bi bi-telephone"></i>
</div>
<div class="content">
<h4>Phone Number</h4>
<p><a href="Tel:18882998146">+1 (888) 299-8146</a></p>
</div>
</div>
<div class="info-item" data-aos="fade-up" data-aos-delay="500">
<div class="icon-box">
<i class="bi bi-envelope"></i>
</div>
<div class="content">
<h4>Email Address</h4>
<a href="mailto: [email protected]"><p> [email protected]</p></a>
</div>
</div>
</div>
</div>
<div class="col-lg-7">
<section style="padding: 0px !important;">
<div class="contact-form" data-aos="fade-up" data-aos-delay="300">
<h3>Get In Touch</h3>
<p>Have questions or need help? Reach out—we’re here for you.</p>
<form id="valForm" name="valForm" method="POST" action="sendmail.php" style="padding: 1em">
<!-- Form fields -->
<div class="row">
<h3 class="mb-4 text-center">Who are we speaking to?</h3>
<div class="col-md-6">
<div class="form-floating mb-4">
<input id="firstname" type="text" name="firstname" class="form-control" placeholder="First Name" required>
<div class="valid-feedback">Looks good!</div>
<div class="invalid-feedback">Please enter your First Name.</div>
</div>
</div>
<div class="col-md-6">
<div class="form-floating mb-4">
<input id="lastname" type="text" name="lastname" class="form-control" placeholder="Last Name" required>
<div class="valid-feedback">Looks good!</div>
<div class="invalid-feedback">Please enter your Last Name.</div>
</div>
</div>
<div class="col-md-6">
<div class="form-floating mb-4">
<input type="text" class="form-control" name="phone" id="phone" placeholder="Phone Number" minlength="10" maxlength="10" required>
<div class="valid-feedback">Looks good!</div>
<div class="invalid-feedback">Please enter your Phone Number.</div>
</div>
</div>
<div class="col-md-6">
<div class="form-floating mb-4">
<input id="email" type="email" name="email" class="form-control" placeholder="Email Address" required>
<div class="valid-feedback">Looks good!</div>
<div class="invalid-feedback">Please enter your Email Address.</div>
</div>
</div>
</div>
<div class="row">
<h3 class="mb-4 mt-3 text-center">What is your Date of Birth?</h3>
<div class="col-md-4 col-sm-12">
<select id="dobmonth" class="form-select" name="month" required>
<!-- Populate with options 01-12 -->
<option value="">Month</option>
<option value="01"> January</option>
<option value="02"> February</option>
<!-- Add all months -->
</select>
</div>
<div class="col-md-4 col-sm-12">
<select id="dobday" class="form-select" name="day" required>
<option value="">Day</option>
<!-- Add day options 01-31 -->
</select>
</div>
<div class="col-md-4 col-sm-12">
<select id="dobyear" class="form-select" name="year" required>
<option value="">Year</option>
<!-- Add year options, e.g. 1900-2025 -->
</select>
</div>
</div>
<h3 class="mb-3 mt-5 text-center">What is your current address?</h3>
<div class="row">
<div class="col-md-12">
<div class="form-floating mb-4">
<input id="address" type="text" name="address" class="form-control" placeholder="Street Address" required>
</div>
</div>
<div class="col-md-4">
<div class="form-floating mb-4">
<input type="text" class="form-control" minlength="5" maxlength="5" name="zip" id="zipCode" placeholder="Zip Code" required>
</div>
</div>
<div class="col-md-4">
<div class="form-floating mb-4">
<input type="text" class="form-control" name="city" id="city" placeholder="City" required>
</div>
</div>
<div class="col-md-4">
<div class="form-floating mb-4">
<input type="text" class="form-control" name="state" id="state" placeholder="State" required>
</div>
</div>
</div>
<div class="container text-center">
<p>By entering your mobile number, opting-in and clicking the "Submit" button below you agree...</p>
<p>Please select the communication channels through which you would like to receive information:</p>
<div class="row justify-content-center mb-4">
<div class="col-3 d-flex justify-content-center">
<input type="checkbox" class="form-check-input" id="phonecheckbox" name="channels[]" value="Phone">
<label for="phonecheckbox">Phone</label>
</div>
<div class="col-3 d-flex justify-content-center">
<input type="checkbox" class="form-check-input" id="smscheckbox" name="channels[]" value="SMS">
<label for="smscheckbox">SMS</label>
</div>
<div class="col-3 d-flex justify-content-center">
<input type="checkbox" class="form-check-input" id="emailcheckbox" name="channels[]" value="Email">
<label for="emailcheckbox">Email</label>
</div>
<div class="col-3 d-flex justify-content-center">
<input type="checkbox" class="form-check-input" id="mailcheckbox" name="channels[]" value="Mail">
<label for="mailcheckbox">Mail</label>
</div>
</div>
<p>Would you like to receive updates regarding your healthcare application status?</p>
<div class="row justify-content-center">
<div class="form-check col-md-2 col-sm-12">
<input class="form-check-input" type="radio" name="updates" id="yes" value="Yes" required>
<label class="form-check-label" for="yes">Yes</label>
</div>
<div class="form-check col-md-2 col-sm-12">
<input class="form-check-input" type="radio" name="updates" id="no" value="No">
<label class="form-check-label" for="no">No</label>
</div>
</div>
<div style="display:none;">
<input type="text" name="website" value="">
</div>
<button type="submit" id="submitButton" class="btn btn-primary mt-4">Submit</button>
</div>
</form>
<div id="formResponse" style="margin-top: 1em;"></div>
</section>
</div>
</div>
</div>
</div>
</section><!-- /Contact Section -->
<div id="formResponse" style="margin-top: 1em;"></div>
<script>
$("#valForm").validate({
rules: {
phone: {
required: true,
minlength: 10,
maxlength: 10
},
firstname: {
required: true
},
lastname: {
required: true
},
email: {
required: true,
email: true
},
city: {
required: true
},
state: {
required: true
},
zip: {
required: true,
minlength: 5,
maxlength: 5
},
month: {
required: true
},
day: {
required: true
},
year: {
required: true
}
},
messages: {
phone: {
required: "Please enter a valid phone number"
}
},
submitHandler: function (form) {
$("#submitButton").prop("disabled", true).text("Sending...");
$.ajax({
url: "sendmail.php",
type: "POST",
data: $(form).serialize(),
dataType: "json",
success: function (response) {
if (response.status === "success") {
$("#formResponse").html('<div class="alert alert-success">' + response.message + '</div>');
form.reset();
} else {
$("#formResponse").html('<div class="alert alert-danger">' + response.message + '</div>');
}
$("#submitButton").prop("disabled", false).text("Submit");
},
error: function (xhr, status, error) {
const errorText = xhr.responseText ? xhr.responseText : "An unknown error occurred.";
$("#formResponse").html('<div class="alert alert-danger">An error occurred. ' + errorText + '</div>');
$("#submitButton").prop("disabled", false).text("Submit");
}
});
}
});
/*-----------------------------------------------------------------------*/
/*----------------------- Phone Number Input Mask -----------------------*/
/*-----------------------------------------------------------------------*/
$(document).ready(function(){
$('#phone').mask('0000000000');
});
/*-----------------------------------------------------------------------*/
/*---------------------------- Zip Code Lookup --------------------------*/
/*-----------------------------------------------------------------------*/
$('#zipCode').on("input",function(){
var zipCode = $('#zipCode').val();
if(zipCode.length == 5)
{
$.ajax({
type: 'GET',
url:'https://ziplookup.visualyzers.com/Ziplookup?zipcode=' + zipCode,
success:function(results){
$('#city').val(results.city);
$('#state').val(results.state);
}
})
}
});
$(function() {
$( "#datepicker" ).datepicker({
dateFormat : 'mm/dd/yy',
changeMonth : true,
changeYear : true,
yearRange: '-100y:c+nn',
maxDate: '-1d'
});
});
/*-----------------------------------------------------------------------*/
/*--------------------------- Date of Birth ----------------------------*/
/*-----------------------------------------------------------------------*/
$(document).ready(function() {
$.getJSON('https://api.ipify.org?format=jsonp&callback=?', function(data) {
$('#IpAddress').val(data.ip);
});
$.dobPicker({
daySelector: '#dobday',
/* Required */
monthSelector: '#dobmonth',
/* Required */
yearSelector: '#dobyear',
/* Required */
dayDefault: 'Day',
/* Optional */
monthDefault: 'Month',
/* Optional */
yearDefault: 'Year',
/* Optional */
minimumAge: 18,
/* Optional */
maximumAge: 100 /* Optional */
});
});
window.dataLayer = window.dataLayer || [];
$.dataLayer.push({
'event':'ec_formsubmit',
'enhanced_conversion_data': {
first_name: $('#firstname').val(),
last_name: $('#lastname').val(),
phone_number: $('#phone').val(),
email_address: $('#email').val(),
street: $('#street').val(),
city: $('#city').val(),
postal_code: $('#zip').val(),
dobday: $('#dobday').val(),
dobmonth: $('#dobmonth').val(),
dobyear: $('#dobyear').val(),
date_of_birth: $('#dob').val(),
plan_condition: $('.planConditions').val(),
plan_option: $('.planOption').val(),
}
})
</script>
<footer id="footer" class="footer">
<div class="container copyright text-center">
© 2025 by The Advocacy Service Center. <a href="/privacy.php">Privacy Policy</a> | <a href="/terms.php">Terms and Conditions</a>
</div>
</footer>
<!-- Scroll Top -->
<a href="/" id="scroll-top" class="scroll-top d-flex align-items-center justify-content-center"><i class="bi bi-arrow-up-short"></i></a>
<!-- Vendor JS Files -->
<script src="assets/vendor/bootstrap/js/bootstrap.bundle.min.js"></script>
<script src="assets/vendor/php-email-form/validate.js"></script>
<script src="assets/vendor/aos/aos.js"></script>
<script src="assets/vendor/glightbox/js/glightbox.min.js"></script>
<script src="assets/vendor/swiper/swiper-bundle.min.js"></script>
<script src="assets/vendor/purecounter/purecounter_vanilla.js"></script>
<!-- Main JS File -->
<script src="assets/js/main.js"></script>
<!-- Medication List -->
<script>
fetch("https://winter-violet-e171.bitter-brook-1355.workers.dev")
.then(response => response.json())
.then(data => {
const list = document.getElementById("medications");
list.innerHTML = "";
// Alphabetical order (optional)
data.sort((a, b) => a.name.localeCompare(b.name));
data.forEach(item => {
if (item.name) {
const li = document.createElement("li");
// Create the check-circle icon for each <li>
const icon = document.createElement("i");
icon.className = "bi bi-check-circle-fill";
// Append icon first, then text
li.appendChild(icon);
li.appendChild(document.createTextNode(item.name));
list.appendChild(li);
}
});
})
.catch(() => {
document.getElementById("medications").innerHTML =
"<li>Unable to load medications.</li>";
});
</script>
<!-- Medication List END -->
<script>
document.getElementById("valForm").addEventListener("submit", function(e) {
let valid = true;
let errors = [];
// Name fields
let first = document.getElementById("firstname").value.trim();
let last = document.getElementById("lastname").value.trim();
if (first.length < 2) { valid = false; errors.push("First name must be at least 2 letters."); }
if (last.length < 2) { valid = false; errors.push("Last name must be at least 2 letters."); }
// Phone (digits only, 10 numbers)
let phone = document.getElementById("phone").value.trim();
if (!/^[0-9]{10}$/.test(phone)) { valid = false; errors.push("Phone number must be 10 digits."); }
// Email
let email = document.getElementById("email").value.trim();
if (!/^[^@]+@[^@]+\.[a-z]{2,}$/i.test(email)) { valid = false; errors.push("Invalid email address."); }
// DOB
if (!document.getElementById("dobmonth").value ||
!document.getElementById("dobday").value ||
!document.getElementById("dobyear").value) {
valid = false;
errors.push("Please complete your Date of Birth.");
}
// Address
let zip = document.getElementById("zipCode").value.trim();
if (!/^[0-9]{5}$/.test(zip)) { valid = false; errors.push("Zip code must be 5 digits."); }
let city = document.getElementById("city").value.trim();
let state = document.getElementById("state").value.trim();
if (city.length < 2) { valid = false; errors.push("City required."); }
if (state.length < 2) { valid = false; errors.push("State required."); }
if (!valid) {
e.preventDefault();
alert("Form errors:\n- " + errors.join("\n- "));
}
});
</script>
</body>
</html>