Comments and Feedback

From Faculty of Medicine Online Museum and Archive

Revision as of 07:16, 29 September 2009 by Kbond (Talk | contribs)
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This site is in development and we welcome your feedback and contributions. Enquiries can also be directed to the managing curator Dr Lise Mellor.


<form name="alumnifeedback" method="post" action="/museum/feedback_dbform.php">

<input type="hidden" name ="db_enqtype" value ="feedback"> <input type="hidden" name="db_time" value="<?=date("d/m/Y G:i")?>" />

First name
<input type="text" name="db_firstname" value="" tabindex="1" >
Surname
<input type="text" name="db_surname" value="" tabindex="2">
Email
<input type="text" name="db_email" tabindex="3">
Phone
<input type="text" name="db_phone" tabindex="6">
Comment
<textarea name="db_comment" cols="60" rows="5" tabindex="10"></textarea>
<input type="submit" name="Submit" value="Submit" tabindex="100">
</form>