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Recreate form in PHP/HTML for MySQL
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IT & Programming > Web Programming

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The client has made the following changes to the job.


Job canceled.

Mar 14, 2011

Job Description

  |  Change History >>


  • Posted: Mon, Mar 14, 2011
  • Time Left: Closed
  • Location: Anywhere
  • Client prefers freelancers from:

    You are still able to submit a proposal for this job.

    The client prefers freelancers from
    a different location.

    You're still able to submit a proposal for this job, regardless of your location.
  • Start: Immediately
  • Budget: Less than $500
  • Fixed Price Job
  • Elance Escrow Protection
  • U.S. freelancers must have W9
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We have an ASP form that needs to be re-created in HTML/PHP and need to be able to submit to MySQL. After submit it needs to send out an email to an specific email address. Email should coitain link to submitted form.

Our current form can be found here:

  [obscured]  /Michiganpain/online_patient_referral_form.htm

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Desired Skills
MySQL Administration, HTML, PHP
Job ID: 23415823
Avg $ | High $ | Low $ — Show Pricing
  • Submit Date (Latest)

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