Urgent PHP-mysql form programming

IN PROGRESS
Bids
8
Avg Bid (USD)
$170
Project Budget (USD)
$30 - $250

Project Description:
1.Urgent Contact us form - programming
simply show confirmation and client side validation
and send all requests to an email we will give you
and confirmation email to user and online message


2.
Urgent Submit Flat Pay request programming
http://zemodo.com/test/PatientCareTransport.com/request-form.html

with Db insert and Db CMS login to show all requests with admin login and ability to change admin and pass in the interface
with basic show all of all records by order date Descending
and ability to change status from pending to Active by CMS admin
and also you need to send emails to user and admin when there is a new record insert

this is php/mysql and we will give you access and u create the Requests table for now

we need to program all fields and validation based on what optional or not
and i need to see all CMS
+ Validation
also when in DB also an email to send to admin and user for the request made with confirmation

also You need to make sure after user register in this form when he click the login button on home page
he will have a username and password login and when he enter he can submit the same request without requiring him to enter all his info(provider)
info again and just the actual request info with patient info


3.http://zemodo.com/test/PatientCareTransport.com/download-forms.html

program this for all states
CA selection will show different set of documents we will give you

You need to add all states and program the next page selection based on state selection CA or all others

after this project you will program a new registration form
in a new project

Skills required:
MySQL, PHP
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