Comments and Feedback
From Faculty of Medicine Online Museum and Archive
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">
</form>
<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"> |