Custom PHP/MySQL Form

This project was awarded to phpgenin for $300 USD.

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Project Budget
$250 - $750 USD
Total Bids
Project Description

Project is to create a 9 page secure custom form for a client in the medical services industry.

It will require expert knowledge of PHP, MySQL, AJAX and Java Scripting.


Previous development experience with transactional databases.

Excellent communication in English.

Ability to follow directions.

Great problem solving skills (we look for developers who work around problems and find creative solutions)

PHP/MySQL - You must be able to show at least 10 complex sites that you have designed.

Java Scripting - AJAX: You should have a very good working knowledge of both and be able to show examples.

The Project:

We are going to be integrating a form that will create a family medical profile into an existing website.

This is a very complex form (approximately 9 pages).

The form will initially be designed based on the standardized form and then modified to the specific needs of the client.

Each form will be reviewed for content and accuracy and then we will need to link the form to the existing database.

Ajax scripting will be used to prompt for additional data based on the response given within the form.

We will modify the searches for the site to reflect the additional data now available to the client.


We will be extremely focused on the aesthetics of the site, accuracy and of course security.

To let me know that you have completely read and understood my requirements, please ask me to "send the standard form"

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