Hello,
I have just now made a simple form. But i want to insert the username and email id of the user already logged in into the form either as label or as hidden text... anyway but i want it emailed into the results.
Below is the code i put into chronoengine.
Thankyou in advance,
Devang
Mumbai, India.
<form id="free_teletherapy" name="free_teletherapy" method="post" action="">
<label>Name
<input name="name" type="text" id="name" />
</label>
<label> Surname
<input type="text" name="surname" id="surname" />
</label>
<p>
<label>Birth Date
<select name="date" id="date">
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>30</option>
<option>31</option>
</select>
</label>
<label>Month
<select name="month" id="month">
<option>Jan</option>
<option>Feb</option>
<option>Mar</option>
<option>Apr</option>
<option>May</option>
<option>Jun</option>
<option>Jul</option>
<option>Aug</option>
<option>Sep</option>
<option>Oct</option>
<option>Nov</option>
<option>Dec</option>
</select>
</label>
<label>Year
<input name="year" type="text" id="year" size="4" maxlength="4" />
</label>
</p>
<p>
<label>Sex
<select name="sex" id="sex">
<option>Male</option>
<option>Female</option>
</select>
</label>
</p>
<p>
<label>Place of Birth :<br />
City
<input name="birthcity" type="text" id="birthcity" size="30" />
</label>
</p>
<p>
<label>State
<input name="birthstate" type="text" id="birthstate" size="30" />
</label>
</p>
<p>
<label>Country
<input name="countrybirth" type="text" id="countrybirth" size="30" />
</label>
</p>
<p></p>
<p>
<label>Brief History of Health Problem
<textarea name="history" cols="70" rows="5" wrap="virtual" id="history"></textarea>
</label>
</p>
<p>
<label>Present Health Symptons
<textarea name="presentsymptons" id="presentsymptons" cols="70" rows="5"></textarea>
</label>
</p>
<p>
<label>Present Location of Patient
<input name="patientlocation" type="text" id="patientlocation" size="30" />
</label>
</p>
<p>
<label>Email
<input type="text" name="email" id="email" />
</label>
</p>
<p>
<input name="emailsubject" type="hidden" id="emailsubject" value="Your Free Teletherapy Form Submission at <!-- w --><a class="postlink" href="http://www.com">www.com</a><!-- w -->" />
<input name="fromemail" type="hidden" id="fromemail" value="abd@abd.org" />
<input name="fromname" type="hidden" id="fromname" value="abc" />
</p>
{imageverification}
<p>
<label>
<input type="submit" name="submit" id="submit" value="Submit" />
</label>
</p>
</form><br><br>Post edited by: beadsboy, at: 2007/06/09 15:41
I have just now made a simple form. But i want to insert the username and email id of the user already logged in into the form either as label or as hidden text... anyway but i want it emailed into the results.
Below is the code i put into chronoengine.
Thankyou in advance,
Devang
Mumbai, India.
<form id="free_teletherapy" name="free_teletherapy" method="post" action="">
<label>Name
<input name="name" type="text" id="name" />
</label>
<label> Surname
<input type="text" name="surname" id="surname" />
</label>
<p>
<label>Birth Date
<select name="date" id="date">
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>30</option>
<option>31</option>
</select>
</label>
<label>Month
<select name="month" id="month">
<option>Jan</option>
<option>Feb</option>
<option>Mar</option>
<option>Apr</option>
<option>May</option>
<option>Jun</option>
<option>Jul</option>
<option>Aug</option>
<option>Sep</option>
<option>Oct</option>
<option>Nov</option>
<option>Dec</option>
</select>
</label>
<label>Year
<input name="year" type="text" id="year" size="4" maxlength="4" />
</label>
</p>
<p>
<label>Sex
<select name="sex" id="sex">
<option>Male</option>
<option>Female</option>
</select>
</label>
</p>
<p>
<label>Place of Birth :<br />
City
<input name="birthcity" type="text" id="birthcity" size="30" />
</label>
</p>
<p>
<label>State
<input name="birthstate" type="text" id="birthstate" size="30" />
</label>
</p>
<p>
<label>Country
<input name="countrybirth" type="text" id="countrybirth" size="30" />
</label>
</p>
<p></p>
<p>
<label>Brief History of Health Problem
<textarea name="history" cols="70" rows="5" wrap="virtual" id="history"></textarea>
</label>
</p>
<p>
<label>Present Health Symptons
<textarea name="presentsymptons" id="presentsymptons" cols="70" rows="5"></textarea>
</label>
</p>
<p>
<label>Present Location of Patient
<input name="patientlocation" type="text" id="patientlocation" size="30" />
</label>
</p>
<p>
<label>Email
<input type="text" name="email" id="email" />
</label>
</p>
<p>
<input name="emailsubject" type="hidden" id="emailsubject" value="Your Free Teletherapy Form Submission at <!-- w --><a class="postlink" href="http://www.com">www.com</a><!-- w -->" />
<input name="fromemail" type="hidden" id="fromemail" value="abd@abd.org" />
<input name="fromname" type="hidden" id="fromname" value="abc" />
</p>
{imageverification}
<p>
<label>
<input type="submit" name="submit" id="submit" value="Submit" />
</label>
</p>
</form><br><br>Post edited by: beadsboy, at: 2007/06/09 15:41