Not a member of Pastebin yet?
Sign Up,
it unlocks many cool features!
- <div class="form-group">
- <p>Have you worn contact Lens before?</p>
- <input type="radio" name="lenses" value="Yes"/> Yes<br>
- <input type="radio" name="lenses" value="No"/> No<br>
- </div>
- <div class="form-group">
- <p>If yes, which type of disposable contact lens have you worn before?</p>
- <input type="checkbox" name="disposable_lens[]" value="Monthly"/> Monthly<br>
- <input type="checkbox" name="disposable_lens[]" value="Daily Disposables"/> Daily Disposables<br>
- </div>
- if(isset($_POST["submit"]))
- {
- if(empty($_POST["lenses"]))
- {
- $error .= '<p><label class="text-danger">Lenses is required</label></p>';
- }
- else
- {
- $lenses = clean_text($_POST["lenses"]);
- }
- if(empty($_POST["disposable_lens"]))
- {
- $error .= '<p><label class="text-danger">Disposable_lens is required</label></p>';
- }
- else
- {
- $disposable_lens = array_map('clean_text', $_POST["disposable_lens"]);
- $mail->Body = join('', array(
- "Outlet: ",
- $_POST['outlet'],
- "<br/>",
- "Full Name: ",
- $_POST['fullname'],
- "<br/>",
- "Email Address: ",
- $_POST['email'],
- "<br/>",
- "Phone Number:",
- $_POST['contact_no'],
- "<br/>",
- "Have you worn contact lens before?: ",
- $_POST['lenses'],
- "<br/>",
- "If yes, which type of disposable contact lens have you worn before?: ",
- join(', ', $_POST['disposable_lens']),
- "<br/>",
- "Appointment Date ",
- $_POST['date'],
- "<br/>",
- "Appointment Time ",
- $_POST['time']
- ));
Add Comment
Please, Sign In to add comment