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Appointment Request form
This demonstrates gathering information to use on your website.
With the exception of SMTP examples, PHPMailer Pro will automatically detect the MTA (Mail Transfer Agent). There is no requirement to add properties for IsQmail, IsSendmail, or IsMail. The properties are deprecated and removed.
<?php
/**
* This is a sample appointment form to demonstrate how
* Form2Mail works.
* The default mail transport is sendmail ( not PHP mail() )
* Also supported, in order, are PHPMailerLite.php or PHPMailer Pro.php
*/
ini_set('display_errors', 1);
ini_set('display_startup_errors', 1);
error_reporting(E_ALL);
$show_form = true;
$reload_form = true;
if (count($_POST) > 0) {
/**
* Check if the hidden honeypot fields are filled out. If not, send a mail.
* there are two honeypot fields, both are initially set with an empty value
* if any are filled in, a bot or hacker is at work, reject
*/
$hacker = false;
if ( isset($_POST['hpot_url']) && !empty($_POST['hpot_url'])) { $hacker=true;unset($_POST['hpot_url']); }
if ( isset($_POST['hpot_okurl']) && !empty($_POST['hpot_okurl'])) { $hacker=true;unset($_POST['hpot_okurl']); }
if ( $hacker === true ) { exit('Unable to process<br>'); }
$hacker = null;unset($hacker);
/* END honeypot bot/hacker check */
require_once "assets/mailer/FormValidator.php";
$show_form = false;
$validator = new codeworxtech\FormValidator('en');
// this shows how to use custom error messages
// $validator->addValidation("Name","required","Please fill in Name");
// $validator->addValidation("Email","email","The input for Email should be a valid email value");
// $validator->addValidation("Email","required","Please fill in Email");
// $validator->addValidation("Comments","nourl","URL NOT allowed");
// language selection (if different from "en" - english)
// $validator->SetLanguage("fr");
// this shows how to use built-in default error messages
$validator->addValidation("Name","required");
$validator->addValidation("Name","nourl");
$validator->addValidation("Email_Address","required");
$validator->addValidation("Email_Address","email");
$validator->addValidation("Appt_desc","required");
$validator->addValidation("Appt_desc","nourl");
if($validator->ValidateForm()) {
$setSender = ['noreply@' . $_SERVER['HTTP_HOST']=>'No Reply (unmonitored)'];
$setRecipient = ['name@yourdomain.com'=>'Your Name'];
$page_title = 'Contact Us Sample Form from: ' . $_SERVER['HTTP_HOST'];
$refreshWaitMinutes = 0;
$required = 'Name,Email_Address,Appt_desc';
$reserved_keys = 'hpot_url,hpot_okurl';
$subject = $page_title;
$supressIP = true;
$useEnvRpt = false;
if (file_exists('assets/mailer/Form2Mail.php')) {
$redirect = "sample_thankyou.php?t=appointments";
require 'assets/mailer/Form2Mail.php';
}
exit();
} else {
$error_hash = $validator->GetErrors();
if ($reload_form) {
foreach($error_hash as $inpname => $inp_err) {
$errorVar = $inpname . '_error';
$$errorVar = '<br /><label id="' . $errorVar . '" class="error" for="' . $inpname . '">▲ ' . $inp_err . '</label>';
}
$show_form = true;
} else {
foreach($error_hash as $inpname => $inp_err) {
echo "<b>$inpname</b>: <span class=\"error-up\">$inp_err</span><br>\n";
}
echo "<br>\n<a href=\"javascript:history.back()\">Try again</a><br>\n";
$show_form = false;
}
foreach ($_POST as $key => $val) {
$$key = $val;
}
}
$show_form = false;
}
if ($show_form === true) {
$ip = filter_var($_SERVER['REMOTE_ADDR'], FILTER_VALIDATE_IP);
$error_bar_ip = '';
if (trim($ip) != '') {
$error_bar_ip = '<span class="wrx-footer-item">Your IP: ' . $ip . ' • ' . gethostbyaddr($ip) . '</span>';
}
?><!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Form2Mail Sample Contact Us form</title>
<link href="https://fonts.googleapis.com/css2?family=Nunito+Sans:wght@400;500;700&display=swap" rel="stylesheet">
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css" integrity="sha512-SfTiTlX6kk+qitfevl/7LibUOeJWlt9rbyDn92a1DqWOw9vWG2MFoays0sgObmWazO5BQPiFucnnEAjpAB+/Sw==" crossorigin="anonymous" referrerpolicy="no-referrer" />
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/bulma/0.9.2/css/bulma.min.css" />
</head>
<body>
<section class="container">
<div class="columns is-multiline">
<div class="column is-10 is-offset-1">
<div class="columns">
<div class="column left">
<h1 class="title is-1">Form2Mail<br>Sample<br>Appointment Request</h1>
<h2 class="subtitle colored is-4">To fully test this sample form:</h2>
<p>
To fully test, add your email address to $setRecipient
in the php code at the top of this form ... then go ahead and submit a test.
</p>
<p>
Note: Your appointment will be confirmed when we reply to your request.
</p>
</div>
<div class="column right has-text-left">
<form method="POST" enctype="multipart/form-data">
<div class="field">
<label class="label" for="Name">Name <span class="required">✱</span></label>
<div class="control">
<input class="input is-medium" type="text" name="Name" required autofocus />
<input type="hidden" name="hidden_Name" value="test hidden" />
</div>
</div>
<div class="field">
<label class="label" for="Email_Address">Email <span class="required">✱</span></label>
<div class="control">
<input class="input is-medium" type="text" name="Email_Address" required />
</div>
</div>
<div class="field is-horizontal" style="margin-bottom:0 !important;">
<div class="field-body">
<div class="field">
<label class="label" for="Appt_Date">Date <small>(yy-mm-dd)</small> <span class="required">✱</span></label>
<div class="control">
<input class="input is-small" type="date" id="Appt_Date" name="Appt_Date" value="" required></input>
</div>
</div>
<div class="field">
<label class="label" for="Appt_Time_Start">Time start <span class="required">✱</span></label>
<div class="control">
<input class="input is-small" type="time" name="Appt_Time_Start" value="09:00" step="900" required></input>
</div>
</div>
<div class="field">
<label class="label" for="Appt_Time_End">Time end <span class="required">✱</span></label>
<div class="control">
<input class="input is-small" type="time" name="Appt_Time_End" value="09:30" step="900" required></input>
</div>
</div>
</div>
</div>
<div class="field">
<label class="label" for="Appt_purpose">Appointment purpose <span class="required">✱</span></label>
<div class="control">
<select class="select is-fullwidth" id="Appt_purpose" name="Appt_purpose" required>
<option value="Meeting">Meeting</option>
<option value="Business">Business</option>
<option value="Lunch">Lunch</option>
<option value="Skype">Skype</option>
</select>
</div>
</div>
<div class="field">
<label class="label" for="Appt_desc">Appointment Description <span class="required">✱</span></label>
<div class="control">
<textarea class="input textarea is-small" name="Appt_desc" style="min-height:4rem;" required></textarea>
</div>
</div>
<div class="field is-viz">
<label class="label" for="hpot_url">Leave blank and submit</label>
<div class="control">
<input class="input is-medium" type="text" id="hpot_url" name="hpot_url" value="" placeholder="Your website url, include http or https" autocomplete="off" />
</div>
</div>
<div class="field is-viz">
<label class="label" for="hpot_okurl">Leave unchecked to submit</label>
<div class="control">
<input type="checkbox" id="hpot_okurl" name="hpot_okurl" value="" />
</div>
</div>
<div class="field">
<div class="control">
<button class="button">
Send Appointment Request
</button>
</div>
</div>
</form>
<span class="required">✱</span> = required<br>
</div>
</div>
</div>
<div class="column is-8 is-offset-2">
<br>
<nav class="level">
<div class="level-left">
<div class="level-item">
<span class="icon">
<a href="https://twitter.com/PHPMailer_2" target="_blank">
<i class="fa fa-twitter fa-lg" title="Follow on Twitter"></i>
</a>
</span>
<span class="icon">
<a href="https://www.facebook.com/groups/phpmailer2" target="_blank">
<i class="fa fa-facebook fa-lg" title="Follow on Facebook"></i>
</a>
</span>
<span class="icon">
<i class="fa fa-github fa-lg" title="Follow on Github"></i>
</span>
<span class="icon">
<a href="mailto:andy@codeworxtech.com?subject=Contact%20Us%20form%20enquiry&body=I%20am%20interested%20%0D%0A%0D%0A" rel="nofollow"
<i class="fa fa-envelope fa-lg" title="Send an Email"></i>
</a>
</span>
</div>
</div>
<div class="level-right">
<small class="level-item" style="color: var(--textLight)">
© Your Copyright Message Here. All Rights Reserved.
</small>
</div>
</nav>
</div>
</div>
</section>
</body>
<style>
:root {
--brandColor: hsl(166, 67%, 51%);
--background: rgb(247, 247, 247);
--textDark: hsla(0, 0%, 0%, 0.66);
--textLight: hsla(0, 0%, 0%, 0.75);
}
body {
background: var(--background);
height: 100vh;
color: var(--textDark);
}
.field:not(:last-child) {
margin-bottom: 1rem;
}
.register {
margin-top: 10rem;
background: white;
border-radius: 10px;
}
.left,
.right {
padding: 2.5rem;
}
.left {
border-right: 5px solid var(--background);
}
.left .title {
font-weight: 800;
letter-spacing: -2px;
}
.left .colored {
color: var(--brandColor);
font-weight: 500;
margin-top: 1rem !important;
letter-spacing: -1px;
}
.left p {
color: var(--textLight);
font-size: 1.15rem;
}
.right .title {
font-weight: 800;
letter-spacing: -1px;
}
.right .description {
margin-top: 1rem;
margin-bottom: 1rem !important;
color: var(--textLight);
font-size: 1.15rem;
}
.right small {
color: var(--textLight);
}
input,
select,
textarea {
font-size: 1.2rem !important;
background-color:#fff !important;
}
input:focus,
select:focus,
textarea:focus {
border-color: var(--brandColor) !important;
box-shadow: 0 0 0 1px var(--brandColor) !important;
}
.select {
max-height: 2.5em !Important;
height: 2.5em !Important;
outline:none;
border:1px solid #DBDBDB;
-webkit-border-radius: 4px;
-moz-border-radius: 4px;
border-radius: 4px;
line-height: 1.5;
padding-bottom: calc(.5em - 1px);
padding-left: calc(.75em - 1px);
padding-right: calc(.75em - 1px);
padding-top: calc(.5em - 1px);
}
.select:hover {
border-color: #b5b5b5;
}
.fa {
color: var(--textLight);
margin-right: 1rem;
}
.is-viz {
display:none;
}
.required {
font-size:0.8rem;
color:red;
}
input[type="date"],
input[type="datetime"],
input[type="time"] {
font-size:0.9rem !important;
}
button.button {
background-color: var(--brandColor) !important;
color: #000;
-webkit-border-radius: 5px;
-moz-border-radius: 5px;
border-radius: 5px;
}
</style>
<script>
var date = new Date();
var day = date.getDate();
var month = date.getMonth() + 1;
var year = date.getFullYear();
if (month < 10) month = "0" + month;
if (day < 10) day = "0" + day;
var today = year + "-" + month + "-" + day;
document.getElementById('Appt_Date').value = today;
</script>
</html>
<?php } ?>Download