In Progress

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.

Thanks,

Darren

Skills: Electronic Forms, HTML, PHP, Website Design

See more: web medical information, mockup web online, booking online web pages, google translate online, medical booking, simple booking php form, online medical form, medical translate, simple web request, simple php booking form, online medical booking, google booking form, convert email text, simple request response, php booking email form, mockup web pages, convert form online form, simple request form, simple text form, php simple booking, simple sign form web, convert web form, translate web pages, simple booking form, form response

About the Employer:
( 9 reviews ) Edmonton, Canada

Project ID: #7445325

Awarded to:

kalidas365

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

$40 CAD in 2 days
(16 Reviews)
3.5

17 freelancers are bidding on average $216 for this job

kchg

Hello! I am interest your project and I hope to work with you. My Ranking is Top 7th on freelancer. I have enough experience with WEB developing for 5+ years. Client satisfaction is my top priority. I will comple More

$309 CAD in 3 days
(270 Reviews)
8.6
toxsltech

A proposal has not yet been provided

$1473 CAD in 19 days
(30 Reviews)
7.2
jfreak53

Good day and thank you for reading my proposal. Microtronix has been in business now for 12 years and has 200 customers in 12 countries of the world. We also have offices in the USA and Guatemala, C.A. We work primaril More

$305 CAD in 1 day
(54 Reviews)
6.8
CindyAdams

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

$40 CAD in 3 days
(37 Reviews)
6.3
majidpervaiz

Hi Darren, Please pass the mockup file so i can take a look and maybe we can negotiate on the price if its easy and will deliver you quickly as i am available to start working right away... View my profile for my quali More

$188 CAD in 3 days
(44 Reviews)
6.0
arhossain

[url removed, login to view] name is Arif Hossain. I'm from Dhaka, Bangladesh. I satisfy my clients by providing high quality work, being responsive and taking pride in my integrity. My Previous Work Link: [url removed, login to view] ht More

$77 CAD in 3 days
(46 Reviews)
5.6
sismaster

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

$83 CAD in 2 days
(90 Reviews)
5.8
InfamyTechnology

Hi, We have expertise in design and development of website. Please discuss in brief so that we can start working on your project. Please have a look on our profile [url removed, login to view] More

$200 CAD in 3 days
(29 Reviews)
5.4
GGInformatica

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
(51 Reviews)
5.1
junkyfunky

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

$100 CAD in 3 days
(17 Reviews)
4.7
seomaster212

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

$59 CAD in 2 days
(39 Reviews)
5.0
phpdeveloper3

Hello, I am a 6+ year experienced php programmer having experience in wordpress custom plugin development and standard plugin usage like EventPro, WooCommerce, NextGen, SbLogin etc and In Joomla i have worked in Virt More

$111 CAD in 1 day
(9 Reviews)
3.9
sanjeev2727

I have experienced in web application development using techologies php, core java, html5, coraldraw, bootstrap 3, illustrator, css3, photoshop, ajax, jquery, javascript, struts, mysql, wordpress, joomla, postgresql, o More

$150 CAD in 3 days
(22 Reviews)
4.2
nadiashams

Sir/Madam, HI. How are you? I am interested in this job.I hope you take my offer in consideration and can guarantee you quality work. Thank in advance.

$44 CAD in 1 day
(7 Reviews)
3.0
nazarfreelance

i checked image, and i can do that very fast and good using bootstrap. you can see from me reviews that i already did this kind of tasks. so just write me asap to start work

$88 CAD in 0 days
(4 Reviews)
2.8
blissitsolutions

Hello Employer, I am a professional Web designer having more than 5 years of experience in Web Designing and Development. I've developed quality designs and development using Photoshop, Illustrator, XHTML and CSS, j More

$237 CAD in 3 days
(0 Reviews)
0.0
zometech

Hello, Thanks for posting your requirement. We understand that you want to develop a website. Our goal is to deliver excellent service built upon an open dialogue with our clients. We have a very flexible skil More

$244 CAD in 3 days
(1 Review)
0.1