Conatc.php
<html>
<head>
<title>
Contact_form
</title>
<link href="http://ajax.googleapis.com/ajax/libs/jqueryui/1.8/themes/base/jquery-ui.css" rel="stylesheet" type="text/css"/>
<script type="text/javascript" src="http://ajax.googleapis.com/ajax/libs/jquery/1.6.2/jquery.min.js"></script>
<script src="http://ajax.googleapis.com/ajax/libs/jqueryui/1.8/jquery-ui.min.js"></script>
<script>
$(document).ready(function() {
$("#datepicker").datepicker();
});
</script>
</head>
<body>
<form name="contactform" method="post" action="send_form_email.php">
<table width="450px">
<tr>
<td valign="top">
<label for="first_name">Name *</label>
</td>
<td valign="top">
<input type="text" name="first_name" maxlength="50" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="email">Email Address *</label>
</td>
<td valign="top">
<input type="text" name="email" maxlength="80" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="telephone">Phone Number</label>
</td>
<td valign="top">
<input type="text" name="telephone" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="date">Date of Appointment *</label>
</td>
<td valign="top">
<input type="text" id="datepicker" name="comments" />
</td>
</tr>
<tr>
<td colspan="2" style="text-align:center">
<input type="submit" value="Submit">
</td>
</tr>
</table>
</form>
</body>
</html>
send_form_email:
<?php
if(isset($_POST['email'])) {
// EDIT THE 2 LINES BELOW AS REQUIRED
$email_to = "mohiddin143143@gmail.com";
$email_subject = "Appoinment_request";
function died($error) {
// your error code can go here
echo "We are very sorry, but there were error(s) found with the form you submitted. ";
echo "These errors appear below.<br /><br />";
echo $error."<br /><br />";
echo "Please go back and fix these errors.<br /><br />";
die();
}
// validation expected data exists
if(!isset($_POST['first_name']) ||
!isset($_POST['email']) ||
!isset($_POST['telephone']) ||
!isset($_POST['comments'])) {
died('We are sorry, but there appears to be a problem with the form you submitted.');
}
$first_name = $_POST['first_name']; // required
$email_from = $_POST['email']; // required
$telephone = $_POST['telephone']; // not required
$comments = $_POST['comments']; // required
$error_message = "";
$email_exp = '/^[A-Za-z0-9._%-]+@[A-Za-z0-9.-]+\.[A-Za-z]{2,4}$/';
if(!preg_match($email_exp,$email_from)) {
$error_message .= 'The Email Address you entered does not appear to be valid.<br />';
}
$string_exp = "/^[A-Za-z .'-]+$/";
if(!preg_match($string_exp,$first_name)) {
$error_message .= 'The First Name you entered does not appear to be valid.<br />';
}
if(strlen($comments) < 2) {
$error_message .= 'The Date you entered do not appear to be valid.<br />';
}
if(strlen($error_message) > 0) {
died($error_message);
}
$email_message = "Form details below.\n\n";
function clean_string($string) {
$bad = array("content-type","bcc:","to:","cc:","href");
return str_replace($bad,"",$string);
}
$email_message .= "First Name: ".clean_string($first_name)."\n";
$email_message .= "Email: ".clean_string($email_from)."\n";
$email_message .= "Telephone: ".clean_string($telephone)."\n";
$email_message .= "Comments: ".clean_string($comments)."\n";
// create email headers
$headers = 'From: '.$email_from."\r\n".
'Reply-To: '.$email_from."\r\n" .
'X-Mailer: PHP/' . phpversion();
@mail($email_to, $email_subject, $email_message, $headers);
?>
<!-- include your own success html here -->
Thank you for contacting us. We will be in touch with you very soon.
<?php
}
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Untitled Document</title>
</head>
<body>
</body>
</html>
<html>
<head>
<title>
Contact_form
</title>
<link href="http://ajax.googleapis.com/ajax/libs/jqueryui/1.8/themes/base/jquery-ui.css" rel="stylesheet" type="text/css"/>
<script type="text/javascript" src="http://ajax.googleapis.com/ajax/libs/jquery/1.6.2/jquery.min.js"></script>
<script src="http://ajax.googleapis.com/ajax/libs/jqueryui/1.8/jquery-ui.min.js"></script>
<script>
$(document).ready(function() {
$("#datepicker").datepicker();
});
</script>
</head>
<body>
<form name="contactform" method="post" action="send_form_email.php">
<table width="450px">
<tr>
<td valign="top">
<label for="first_name">Name *</label>
</td>
<td valign="top">
<input type="text" name="first_name" maxlength="50" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="email">Email Address *</label>
</td>
<td valign="top">
<input type="text" name="email" maxlength="80" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="telephone">Phone Number</label>
</td>
<td valign="top">
<input type="text" name="telephone" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="date">Date of Appointment *</label>
</td>
<td valign="top">
<input type="text" id="datepicker" name="comments" />
</td>
</tr>
<tr>
<td colspan="2" style="text-align:center">
<input type="submit" value="Submit">
</td>
</tr>
</table>
</form>
</body>
</html>
send_form_email:
<?php
if(isset($_POST['email'])) {
// EDIT THE 2 LINES BELOW AS REQUIRED
$email_to = "mohiddin143143@gmail.com";
$email_subject = "Appoinment_request";
function died($error) {
// your error code can go here
echo "We are very sorry, but there were error(s) found with the form you submitted. ";
echo "These errors appear below.<br /><br />";
echo $error."<br /><br />";
echo "Please go back and fix these errors.<br /><br />";
die();
}
// validation expected data exists
if(!isset($_POST['first_name']) ||
!isset($_POST['email']) ||
!isset($_POST['telephone']) ||
!isset($_POST['comments'])) {
died('We are sorry, but there appears to be a problem with the form you submitted.');
}
$first_name = $_POST['first_name']; // required
$email_from = $_POST['email']; // required
$telephone = $_POST['telephone']; // not required
$comments = $_POST['comments']; // required
$error_message = "";
$email_exp = '/^[A-Za-z0-9._%-]+@[A-Za-z0-9.-]+\.[A-Za-z]{2,4}$/';
if(!preg_match($email_exp,$email_from)) {
$error_message .= 'The Email Address you entered does not appear to be valid.<br />';
}
$string_exp = "/^[A-Za-z .'-]+$/";
if(!preg_match($string_exp,$first_name)) {
$error_message .= 'The First Name you entered does not appear to be valid.<br />';
}
if(strlen($comments) < 2) {
$error_message .= 'The Date you entered do not appear to be valid.<br />';
}
if(strlen($error_message) > 0) {
died($error_message);
}
$email_message = "Form details below.\n\n";
function clean_string($string) {
$bad = array("content-type","bcc:","to:","cc:","href");
return str_replace($bad,"",$string);
}
$email_message .= "First Name: ".clean_string($first_name)."\n";
$email_message .= "Email: ".clean_string($email_from)."\n";
$email_message .= "Telephone: ".clean_string($telephone)."\n";
$email_message .= "Comments: ".clean_string($comments)."\n";
// create email headers
$headers = 'From: '.$email_from."\r\n".
'Reply-To: '.$email_from."\r\n" .
'X-Mailer: PHP/' . phpversion();
@mail($email_to, $email_subject, $email_message, $headers);
?>
<!-- include your own success html here -->
Thank you for contacting us. We will be in touch with you very soon.
<?php
}
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Untitled Document</title>
</head>
<body>
</body>
</html>