Build a Simple Web Form

I would like an online booking for for people who would like to request a medical with one of our doctors. Basically, it will be in a frame inside one of our existing web pages. I would like you to program the form itself and include a google translate option to convert the text to other languages. Once submitted, the form gets emailed to one of our internal email addresses and the person who submits the form receives and email response with some information on it.

I have a mockup of what I would like it to look like.



Skills: Electronic Forms, HTML, PHP, Website Design

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About the Employer:
( 9 reviews ) Edmonton, Canada

Project ID: #7445325

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Hello, Thank you so much for posting a suitable project here! I have reviewed your requirements, attached mockup well and understood my job. I am professional website developer and here are live url of my clients More

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16 freelancers are bidding on average $225 for this job


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Hii Sir This is poonam individual freelancer, The description that you have posted is well understood and i am ready to discuses now. I can do this easily please show me what you have and how you would like to More

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I can help you make this form Today, If you can message me more details it would be really great and i can show u some of my previous work

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Hello, I've read your project description and I want to let u know that I can build the contact form as per your requirements with mobile friendly responsive design in PHP within 3 days. I'll charge you for this pr More

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Hello my friend, I'm very interested on your project. I'm sure that I can provide you a great work. I have a lot of examples of similar projects like this if you want to see. Regards, Angelo (System Analyst and We More

$111 CAD in 3 days
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Thank you for taking the time to read our initial posting, we have read initial project description and wanted to discuss further thru\' Freelancer PMB. So, please drop us a message from Freelancer PMB, we can then dis More

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