Make a page with a form which can be submitted on our Phpbb forum
We consists a website with a Phpbb forum on it and we want to have a page created on the forum where people that are logged in, can submit a form that can be emailed to us or else entered into a database we can privately access (whichever is more cost effective)
The form will have the following fields-
First Name-
Last Name-
Date of Birth (mm/dd/yyyy)-
Address-
Phone Number-
E-Mail Address-
Representative- (Drop down)
Procedure- (Drop down)
Procedure Date (mm/dd/yyyy)-
Before Weight-
After Weight (pounds)-
(All of the above information must be required for submission)
Testimonial field- text area (min. 200 words to max 500 words)
Video Upload (Optional) - So they can submit a video
Before Picture (Required-
After Picture (Required)-
Additional Picture (Optional)-
Desired Skills are MySQL Administration, HTML, PHP, Database Programming