[SOLVED] PHP form help needed. Error found!

mekhoo · November 11, 2008

Hi all,

I'm new to php so please bear with me if i ask stupid question :-[ . I need to create a registration form with html that post to php and send to my email.

When I tested, i found this error message but this line is needed. Any idea how to solve this problem? My knowledge to php is zero.

Parse error: syntax error, unexpected '=' in i:\domains\uagrp.com\wwwroot\test\sendform.php on line 6

Please see codes below:

And This is the PHP codes:

<?

$ip = $_POST['ip'];

$httpagent = $_POST['httpagent'];

$httpref = $_POST['$httpref'];

$patient_name = $_POST['patient_name'];

$ic-passport_no = $_POST['ic-passport_no']; //**LINE 6 where the error is stated

$date_born_day = $_POST['date_born_day'];

$date_born_month = $_POST['date_born_month'];

$date_born_year = $_POST['date_born_year'];

$Gender = $_POST['Gender'];

$marital_status = $_POST['marital_status'];

$address = $_POST['address'];

$country = $_POST['country'];

$medical_condition = $_POST['medical_condition'];

$contact_person = $_POST['contact_person'];

$Email = $_POST['Email'];

$telephone_home = $_POST['telephone_home'];

$telephone_office = $_POST['telephone_office'];

$handphone = $_POST['handphone'];

$preferred_contact = $_POST['preferred_contact'];

$call_time = $_POST['call_time'];

//************************

//*******Email body

//************************

$subject = "Making Appointment";

/* To send HTML mail, you can set the Content-type header. */

$headers = "MIME-Version: 1.0\r\n";

$headers .= "Content-type: text/html; charset=iso-8859-1\r\n";

$message = "From: $patient_name ($Email) \n

Patients' name: $patient_name \n

Identity card/Passport no.: $ic-passport_no \n

Date of Birth.: $date_born_day - date_born_month - date_born_year \n

Gender: $Gender \n

Marital Status: $marital_status \n

Address: $address \n

country: $country \n

Medical condition: $medical_condition \n

Contact person: $contact_person \n

Email: $Email \n

Telephone Home: $telephone_home \n

Telephone Office: $telephone_office \n

Handphone: $handphone \n

Preferred contact: $preferred_contact \n

Call time: $call_time \n

";

$from = "From: $Email\r\n";

mail("[email protected]", $subject, $message, $from);

$screenout = str_replace("\n", "<br/>", $message);

?>

<?php echo _POST['$screenout']; ?>

</p>

HTML codes are below:

<tr>

<td width="34%" valign="top">* Patient’s Name</td>

(as in Identity Card/ Passport) </label></td>

</tr>

<tr>

<td valign="top">* Patient’s IC/Passport No. </td>

</tr>

<tr>

<td valign="top">* Date of Birth</td>

<option>Month</option>

<option

value="1">Jan </option>

<option

value="4">Apr </option>

<option

value="9">Sep </option>

<option

value="12">Dec</option>

</select>

<select

name="date_born_day" id="date_born_day">

<option

value="13">13 </option>

</select>

<select

name="date_born_year" id="date_born_year">

</select>

</span></td>

</tr>

<tr>

<td valign="top">* Gender</td>

<option>Select gender</option>

<option value="Female">Female</option>

</select>

</label></td>

</tr>

<tr>

<td valign="top">* Marital Status</td>

<option>Select marital status</option>

<option value="Single">Single</option>

<option value="Married">Married</option>

<option value="Separated">Separated</option>

<option value="Divorced">Divorced</option>

</select>

</label></td>

</tr>

<tr>

<td valign="top">* Address</td>

</tr>

<tr>

<td valign="top">* Country </td>

<option>Choose a Country</option>

<option value="SGP">Singapore</option>

<option value="USA">United states of America</option>

<option value="CAN">Canada</option>

<option value="DEU">Germany</option>

<option value="FRA">France</option>

<option value="GBR">United Kingdom</option>

<option value="IND">India</option>

</select></td>

</tr>

<tr>

<td valign="top">* Your Medical Condition</td>

</tr>

<tr>

<td valign="top">* Name (if contact person is different<br />

from above patient’s name) </td>

</label></td>

</tr>

<tr>

<td valign="top">* Email</td>

</label></td>

</tr>

<tr>

<td valign="top">* Telephone (Home)</td>

</tr>

<tr>

<td valign="top">* Telephone (Office)</td>

</tr>

<tr>

<td valign="top">* Handphone</td>

</tr>

<tr>

<td valign="top">Fax number </td>

</tr>

<tr>

<td valign="top">Preferred contact</td>

<option>Select contact</option>

<option value="Telephone-home">Telephone-home</option>

<option value="Telephone-office">Telephone-office</option>

<option value="Handphone">Handphone</option>

</select>

</label>

</td>

</tr>

<tr>

<td valign="top">Please call me at </td>

<option>Select call time</option>

<option value="after 6pm">after 6pm</option>

</select>

</label></td>

</tr>

<tr>

</tr>

<tr>

</tr>

<tr>

</tr>

</table>

</form>

ammu412 · November 11, 2008

hi,

Php variable does not suport "-". But in your program u have added - in ic-passport_no. Change the variable to ic_passport_no.But we can use _ in variable name.

mekhoo · November 11, 2008

Thank you very much. it works!

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[SOLVED] PHP form help needed. Error found!

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