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<%@ Page Language="VB" AutoEventWireup="false" CodeFile="Default.aspx.vb" Inherits="_Default" %>

<!DOCTYPE html>

<html xmlns="http://www.w3.org/1999/xhtml">
<head runat="server">
    <title>St. Clair Medical Services Patient Satisfaction Survey</title>
     <style>
        body{font-family:Arial;}
        h2{color:#0e8dc4;}
        h3{color:#0e8dc4;}
        h5{color:black;}
        p{font-size:small;}
        table{table-layout:fixed; width:100%;}
    </style>
    
    <script type="text/javascript">
        function mytestfunction() {
            alert('display this');

            document.getElementByID('lbl_Error').style.color = 'red';
            document.getElementByID('demo').innerHTML = 'what is going on';
        }

        function WhatChosen() {
            alert('You chose these items to submit!');
        }

    </script>
</head>
<body>
    <form id="form1" runat="server">
    <div style="margin-left:auto; margin-right:auto; width:1000px;">

        <table>
            <tr>
                <td>
                    <!--<img src="https://www.stclair.org/media/img/stClairLogo_529FD3.png" />-->
                    <img src="logo.png" />
                </td>                
                <td style="text-align:center; vertical-align:text-bottom;">
                    <h2> &nbsp; &nbsp; Patient Satisfaction Survey</h2>
                </td>
            </tr>
        </table>
        
        <h2>How Are We Doing?</h2>
        
        <fieldset id="fieldset_Survey" runat="server">
                <p>
                    Please take a few minutes to fill out this survey on the timeliness and quality of the service you received today.
                    St. Clair Physicians welcomes your feedback and your answers will be kept confidential.  Thank you for your participation.
                </p>
        
                <div style="border-top:1px solid navy; background-color:lightgray;">
                    <h3 style="margin-left:5px;">Physician Billing Service</h3>
                </div>

                <hr style="width:100%; margin-top:10px;" />
                <p style="color:#0e8dc4; margin-top:0px; margin-bottom:10px;">Please tell us about your most recent experience with our Physican Billing Service by rating the following:</p>

                <table>
                    <tr>
                        <td>&nbsp;</td>
                        <td>&nbsp;</td>
                        <td style="text-align:right;">
                            <h5>5&nbsp;</h5>
                        </td>
                        <td style="text-align:right;">
                            <h5>4&nbsp;</h5>
                        </td>
                        <td style="text-align:right;">
                            <h5>3&nbsp;</h5>
                        </td>
                        <td style="text-align:right;">
                            <h5>2&nbsp;</h5>
                        </td>
                        <td style="text-align:right;">
                            <h5>1&nbsp;</h5>
                        </td>
                        <td style="text-align:right;">
                            <h5>N/A</h5>
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2" style="text-align:center;">
                            <p>Ability to reach an associate within a reasonable amount of time:</p>
                        </td>
                       <td colspan="6" style="text-align:right;">
                            <asp:RadioButtonList ID="Question_1" runat="server" RepeatDirection="Horizontal">
                                <asp:ListItem Text="" Value="Outstanding"></asp:ListItem>
                                <asp:ListItem Text="" Value="Very_Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Fair"></asp:ListItem>
                                <asp:ListItem Text="" Value="Poor"></asp:ListItem>
                                <asp:ListItem Text="" Value="N/A"></asp:ListItem>
                            </asp:RadioButtonList>
                            <asp:RequiredFieldValidator ID="rfv_question_1" runat="server" ControlToValidate="question_1"
                                 ErrorMessage="Required: Please answer this question before submitting!" ValidationGroup="Survey_Data" ForeColor="Red" />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2" style="text-align:center;">
                            <p>Friendliness and courtesy of the associate:</p>
                        </td>
                       <td colspan="6" style="text-align:right;">
                            <asp:RadioButtonList ID="Question_2" runat="server" RepeatDirection="Horizontal">
                                <asp:ListItem Text="" Value="Outstanding"></asp:ListItem>
                                <asp:ListItem Text="" Value="Very_Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Fair"></asp:ListItem>
                                <asp:ListItem Text="" Value="Poor"></asp:ListItem>
                                <asp:ListItem Text="" Value="N/A"></asp:ListItem>
                            </asp:RadioButtonList>
                            <asp:RequiredFieldValidator ID="rfv_question_2" runat="server" ControlToValidate="question_2"
                                 ErrorMessage="Required: Please answer this question before submitting!" ValidationGroup="Survey_Data" ForeColor="Red" />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2" style="text-align:center;">
                            <p>Associate's willingness to listen carefully to you:</p>
                        </td>
                        <td colspan="6" style="text-align:right;">
                            <asp:RadioButtonList ID="Question_3" runat="server" RepeatDirection="Horizontal">
                                <asp:ListItem Text="" Value="Outstanding"></asp:ListItem>
                                <asp:ListItem Text="" Value="Very_Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Fair"></asp:ListItem>
                                <asp:ListItem Text="" Value="Poor"></asp:ListItem>
                                <asp:ListItem Text="" Value="N/A"></asp:ListItem>
                            </asp:RadioButtonList>
                            <asp:RequiredFieldValidator ID="rfv_question_3" runat="server" ControlToValidate="question_3"
                                 ErrorMessage="Required: Please answer this question before submitting!" ValidationGroup="Survey_Data" ForeColor="Red" />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2" style="text-align:center;">
                            <p>Associate's taking time to answer your questions:</p>
                        </td>
                        <td colspan="6" style="text-align:right;">
                            <asp:RadioButtonList ID="Question_4" runat="server" RepeatDirection="Horizontal">
                                <asp:ListItem Text="" Value="Outstanding"></asp:ListItem>
                                <asp:ListItem Text="" Value="Very_Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Fair"></asp:ListItem>
                                <asp:ListItem Text="" Value="Poor"></asp:ListItem>
                                <asp:ListItem Text="" Value="N/A"></asp:ListItem>
                            </asp:RadioButtonList>
                            <asp:RequiredFieldValidator ID="rfv_question_4" runat="server" ControlToValidate="question_4"
                                 ErrorMessage="Required: Please answer this question before submitting!" ValidationGroup="Survey_Data" ForeColor="Red" />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2" style="text-align:center;">
                            <p>Associate's ability to explain things to you in a clear and concise manner:</p>
                        </td>
                        <td colspan="6" style="text-align:right;">
                            <asp:RadioButtonList ID="Question_5" runat="server" RepeatDirection="Horizontal">
                                <asp:ListItem Text="" Value="Outstanding"></asp:ListItem>
                                <asp:ListItem Text="" Value="Very_Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Fair"></asp:ListItem>
                                <asp:ListItem Text="" Value="Poor"></asp:ListItem>
                                <asp:ListItem Text="" Value="N/A"></asp:ListItem>
                            </asp:RadioButtonList>
                            <asp:RequiredFieldValidator ID="rfv_question_5" runat="server" ControlToValidate="question_5"
                                 ErrorMessage="Required: Please answer this question before submitting!" ValidationGroup="Survey_Data" ForeColor="Red" />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2" style="text-align:center;">
                            <p>Associate's ability to solve your problem:</p>
                        </td>
                        <td colspan="6" style="text-align:right;">
                            <asp:RadioButtonList ID="Question_6" runat="server" RepeatDirection="Horizontal">
                                <asp:ListItem Text="" Value="Outstanding"></asp:ListItem>
                                <asp:ListItem Text="" Value="Very_Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Fair"></asp:ListItem>
                                <asp:ListItem Text="" Value="Poor"></asp:ListItem>
                                <asp:ListItem Text="" Value="N/A"></asp:ListItem>
                            </asp:RadioButtonList>
                            <asp:RequiredFieldValidator ID="rfv_question_6" runat="server" ControlToValidate="question_6"
                                 ErrorMessage="Required: Please answer this question before submitting!" ValidationGroup="Survey_Data" ForeColor="Red" />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2" style="text-align:center;">
                            <p>Overall quality of the online bill pay service:</p>
                        </td>
                        <td colspan="6" style="text-align:right;">
                            <asp:RadioButtonList ID="Question_7" runat="server" RepeatDirection="Horizontal">
                                <asp:ListItem Text="" Value="Outstanding"></asp:ListItem>
                                <asp:ListItem Text="" Value="Very_Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Fair"></asp:ListItem>
                                <asp:ListItem Text="" Value="Poor"></asp:ListItem>
                                <asp:ListItem Text="" Value="N/A"></asp:ListItem>
                            </asp:RadioButtonList>
                            <asp:RequiredFieldValidator ID="rfv_question_7" runat="server" ControlToValidate="question_7"
                                 ErrorMessage="Required: Please answer this question before submitting!" ValidationGroup="Survey_Data" ForeColor="Red" />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2" style="text-align:center;">
                            <p>Overall ease and convenience of the billing process:</p>
                        </td>
                        <td colspan="6" style="text-align:right;">
                            <asp:RadioButtonList ID="Question_8" runat="server" RepeatDirection="Horizontal">
                                <asp:ListItem Text="" Value="Outstanding"></asp:ListItem>
                                <asp:ListItem Text="" Value="Very_Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Fair"></asp:ListItem>
                                <asp:ListItem Text="" Value="Poor"></asp:ListItem>
                                <asp:ListItem Text="" Value="N/A"></asp:ListItem>
                            </asp:RadioButtonList>
                            <asp:RequiredFieldValidator ID="rfv_question8" runat="server" ControlToValidate="question_8"
                                 ErrorMessage="Required: Please answer this question before submitting!" ValidationGroup="Survey_Data" ForeColor="Red" />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2" style="text-align:center;">
                            <p>Your overall satisfaction with our Physician Billing Service:</p>
                        </td>
                        <td colspan="6" style="text-align:right;">
                            <asp:RadioButtonList ID="Question_9" runat="server" RepeatDirection="Horizontal">
                                <asp:ListItem Text="" Value="Outstanding"></asp:ListItem>
                                <asp:ListItem Text="" Value="Very_Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Good"></asp:ListItem>
                                <asp:ListItem Text="" Value="Fair"></asp:ListItem>
                                <asp:ListItem Text="" Value="Poor"></asp:ListItem>
                                <asp:ListItem Text="" Value="N/A"></asp:ListItem>
                            </asp:RadioButtonList>
                            <asp:RequiredFieldValidator ID="rfv_question_9" runat="server" ControlToValidate="question_9"
                                 ErrorMessage="Required: Please answer this question before submitting!" ValidationGroup="Survey_Data" ForeColor="Red" />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="8">
                            <hr />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="8" style="text-align:right;">
                            <asp:Button ID="btn_Submit_Survey" runat="server" Text="Submit" CausesValidation="true" ValidationGroup="Survey_Data" />
                        </td>
                    </tr>
                    <tr>
                        <td colspan="8" style="text-align:right;">
                            <asp:ValidationSummary ID="val_summary_Survey" runat="server" ShowSummary="false" ShowValidationErrors="true"
                                 DisplayMode="List" ValidationGroup="Survey_Data"  ShowMessageBox="false" />                                                
                            <label id="lbl_Error" style="color:red;"></label>                            
                        </td>
                    </tr>
                </table>
            </fieldset>
          
        <fieldset id="fieldset_completed" runat="server" visible="false">
            <br /><br />
            <table cellspacing="3" cellpadding="1">
                <tr>
                    <td>
                        <span>&nbsp;&nbsp;Thank you for taking the time to complete the survey!  Please close this browser window.</span>
                    </td>
                </tr>
            </table>
            <br /><br />
        </fieldset>

        <fieldset id="fieldset_error" runat="server" visible="false">
            <br /><br />
            <table cellspacing="3" cellpadding="1">
                <tr>
                    <td>
                        <span>&nbsp;&nbsp;There was an error saving your answers.  Please try again later.</span>
                    </td>
                </tr>
            </table>
            <br /><br />
        </fieldset>
          
    </div>
    </form>
</body>
</html>