<?php
var_dump($_POST);

$hostname = 'hostname';
$dbname = 'dbname';
$username = 'username';
$password = 'password';

$con=mysql_connect($hostname,$username,$password) or die("Failed to connect to MySQL: " . mysql_error());
$db=mysql_select_db($dbname,$con) or die("Failed to connect to MySQL: " . mysql_error());

$insert = "INSERT INTO Booking_request_form (Treatment, Date, Time, Message) VALUES('".$_POST["Treatment"]."','".$_POST["Date"]."', '".$_POST["Time"]."', '".$_POST["Message"]."')";

var_dump($insert);
$handle = mysql_query($insert);
var_dump($handle);

?>

<form action="treatment_form.php" method="post">
    <div class="heading1">
        <p>Select Your Treatment:</p>
    </div>

    <div class="dropdown">
        <select><?php echo $options; ?></select>
    </div>

    <div class="heading2">
        <p>Select Your Date:</p>
            <input type="text" id="datepicker"/>
                <script>
                $(function() {
                    $( "#datepicker" ).datepicker({dateFormat: 'dd/mm/yy'});
                });
                </script>
    </div>

    <div class="heading3">
        <p>Select Your Time:</p>
            <input type="text" id="timepicker"/>
            <!-- <script>
            $(function($) {
                $(function() {
                    $('input.timepicker').timepicker();
                });
            })(jQuery);
            </script> -->
    </div>

    <div class="heading4">
        <p>Add a message for our Staff:</p>
        <textarea name="message" placeholder="Enter Message..."></textarea>
    </div>

    <div class="submit">
        <input type="submit" value="Request Booking" id="Submit">
    </div>
</form>