The latest project that has been thrust upon me is to try to get an online form working that can be submitted with the results via email. I have managed to get most of the form elements working, but some of the radio buttons are giving me fits. I've been working on this for 2 days and just can't figure out where I'm going wrong, so I'm begging for some help from those more knowledgeable than myself. Hopefully I get the code posted correctly below:
Here is my code on my webpage for the form:
[text]
<form id="form1" name="form1" action="send-email-volunteer-activity-form.php" method="post">
<div align="left"><a name="TemplateInfo"></a>
</div>
<h1 align="left">Volunteer Activity Form</h1>
<p align="left">Current Desert Oasis Hospice Volunteers can now submit your Volunteer Activity Forms online.<br />
<br />
Volunteer Name: <input name="volunteer_name" id="volunteer_name" type="text" value="" size="50" maxlength="50"><br>
Patient's Initials: <input name="patients_initials" id="patients_initials" type="text" size="50" maxlength="50"><br>
Visit Date: <input name="visit_date" id="visit_date" type="text" size="50" maxlength="50"><br><br>
<strong>REMEMBER:</strong><br>
Documentation of your activity should be turned in within 48 hours of your visit to the Volunteer Coordinator.<br><br>
<strong>Type of Service:</strong><br>
<input type="radio" name="type_of_service" id="type_of_service" value="visit">Visit<br>
<input type="radio" name="type_of_service" id="type_of_service" value="refused_visit">Refused Visit<br>
<input type="radio" name="type_of_service" id="type_of_service" value="administrative_support">Administrative Support<br>
<input type="radio" name="type_of_service" id="type_of_service" value="bereavement">Bereavement<br>
<input type="radio" name="type_of_service" id="type_of_service" value="treasure_chest_volunteer">Treasure Chest Volunteer<br>
<input type="radio" name="type_of_service" id="type_of_service" value="volunteer_training">Volunteer Training<br>
<input type="radio" name="type_of_service" id="type_of_service" value="inservice_meeting">In-Service/meeting<br>
Other: <input type="text" name="type_of_service" id="type_of_service" value="" size="100" maxlength="150"><br />
<br />
<strong>Services Provided:</strong><br>
<input type="radio" name="services_provided" id="services_provided" value="patient_support_companionship">Patient Support/Companionship<br>
<input type="radio" name="services_provided" id="services_provided" value="caregiver_support_companionship">Caregiver support/companionship<br>
<input type="radio" name="services_provided" id="services_provided" value="provided_music">Provided Music<br>
<input type="radio" name="services_provided" id="services_provided" value="crafts">Crafts<br>
Other: <input type="text" name="services_provided" id="services_provided" value="" size="100" maxlength="150"><br />
<br>
<strong>Hours Worked: </strong><br>
Start Time:<input name="hours_worked_start_time" id="hours_worked_start_time" type="text" value="" size="10" maxlength="10"> <input type="radio" name="start_time" id="start_time" value="AM" />AM <input type="radio" name="start_time" id="start_time" value="PM" />PM
<br />
End Time: <input name="hours_worked_end_time" id="hours_worked_end_time" type="text" value="" size="10" maxlength="10"> <input type="radio" name="end_time" id="end_time" value="AM" />AM <input type="radio" name="end_time" id="end_time" value="PM" />PM<br>
<br><br>
<strong>Total Time Including Travel Time:</strong> (round to quarter hour)
<input name="total_time" id="total_time" type="text" value="" size="20" maxlength="20"><br>
<br><br>
<strong>Observations/Concerns/Comments: </strong>(for urgent issues please call 602-424-4204 immediately)<br>
<textarea name="observations_concerns_comments" id="observations_concerns_comments" cols="100" rows="30" wrap="hard"></textarea><br />
<br />
<strong> Volunteer's Signature:</strong> <font size="-2">(By typing your full name here, this acts as your signature in an electronic version)</font>
<input name="volunteer_signature" id="volunteer_signature" type="text" value="" size="50" maxlength="50">
Date: <input name="date_signed" id="date_signed" type="text" value="" size="20" maxlength="20"><br><br />
<br />
<br />
<input type="submit" name="submit" id="sumbit" value="Send" />
</form>
[/text]
And here is my PHP send mail code:
Code: Select all
<?php
// loop through every form field
/*
while( list( $field, $value ) = each( $_POST )) {
// display values
if( is_array( $value )) {
// if checkbox (or other multiple value fields)
while( list( $arrayField, $arrayValue ) = each( $value ) ){
echo "<p>' . $arrayValue . '</p>\n";
}
} else {
echo "<p>' . $value . '</p>\n";
}
}
*/
$email_message = "" ;
$email_message .= '<h2>Volunteer Activity Form </h2>';
$email_message .= '<table width="600" border="0" cellspacing="0" cellpadding="0">';
$email_message .= '<tr>';
$email_message .= '<td width="168" align="left" valign="top"> </td>';
$email_message .= '<td width="46" align="left" valign="top"> </td>';
$email_message .= '<td width="386" align="left" valign="top"> </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top">Volunteer Name </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top">' . $_POST['volunteer_name'] . ' </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top">Patient Initials </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top">' . $_POST['patients_initials'] . '</td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top">Visit Date </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top">' . $_POST['visit_date'] . ' </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td colspan="3" align="left" valign="top"><h3>Services:</h3></td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top">Type of Service</td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top">';
$email_message .= $_POST['type_of_service'] ;
$email_message .= '</td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top">Services Provided</td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top">' . $_POST['services_provided'] . ' </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td colspan="3" align="left" valign="top"><h3>Hours Worked:</h3></td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top">Start Time</td>';
$email_message .= '<td align="left" valign="top">' . $_POST['hours_worked_start_time'] . '</td>';
$email_message .= '<td align="left" valign="top">' . $_POST['start_time'] . '</td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top">End Time</td>';
$email_message .= '<td align="left" valign="top">' . $_POST['hours_worked_end_time'] . '</td>';
$email_message .= '<td align="left" valign="top">' . $_POST['end_time'] . '</td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top">Total time including travel time</td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top">' . $_POST['total_time'] . ' </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td colspan="3" align="left" valign="top"><h3>Observations/Concerns/Comments:</h3></td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top">Comments:</td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top">' . $_POST['observations_concerns_comments'] . ' </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td colspan="3" align="left" valign="top"><h3>Volunteer Signature:</h3></td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td colspan="2" align="left" valign="top">Volunteers Signature: (By typing your full name here, this acts as your signature in an electronic version)</td>';
$email_message .= '<td align="left" valign="top">' . $_POST['volunteer_signature'] . ' </td>';
$email_message .= '</tr>';
$email_message .= '<tr>';
$email_message .= '<td align="left" valign="top">Date Signed</td>';
$email_message .= '<td align="left" valign="top"> </td>';
$email_message .= '<td align="left" valign="top">' . $_POST['date_signed'] . ' </td>';
$email_message .= '</tr>';
$email_message .= '</table>';
// EDIT THE 2 LINES BELOW AS REQUIRED
// $email_to = "ejaehnig@geriatricsolutionsllc.com";
$email_to = "test@desertoasishospice.com";
$email_subject = "Volunteer Activity Form";
$email_from = "test@desertoasishospice.com";
// create email headers
$headers = 'From: '.$email_from."\r\n".
$headers .= "Content-type: text/html\r\n";
'Reply-To: '.$email_from."\r\n" .
'X-Mailer: PHP/' . phpversion();
@mail($email_to, $email_subject, $email_message, $headers);
// success. sends you to the thank you pge
header( 'Location: /volunteeractivityformsubmission.htm' ) ;
?>
<!-- include your own success html here -->
Thank you for submitting your Volunteer Activity Form. We greatly appreciate your continued service to Desert Oasis Hospice patients and their families!
[text]Volunteer Activity Form
Volunteer Name Jane Smith
Patient Initials WB
Visit Date 7/5/13
Services:
Type of Service
Services Provided
Hours Worked:
Start Time 4:00 PM
End Time 4:30 PM
Total time including travel time 0.5
Observations/Concerns/Comments:
Comments: none
Volunteer Signature:
Volunteers Signature: (By typing your full name here, this acts as your signature in an electronic version) Jane Smith
Date Signed 7/12/13
[/text]
So you can see my radio buttons for the AM/PM time are working in the email, but the radio buttons for "type of service" and "services provided" are not.
HELP! What am I doing wrong?
Thank you greatly in advance!!