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Create two online forms

Hi,

I have a website called [url removed, login to view] and i have two zoho forms on my website (from [url removed, login to view]) - they are integral to the purpose of my website, but at times slow my website load time. Also zoho creator often has down times, this is damaging to my site and i don't want to rely on them for uptime. (i am however fine to keep them for the database service and reporting services etc on the backend, but also open to alternative suggestions for database hosting and reporting..)

Some key points for this project:

firstly PLEASE DO NOT SUBMIT BLANK/DUMMY ENTRIES TO THE FORM TO TEST IT - AS IT WILL SCREW UP MY DATABASE

1. I want to replace the zoho forms with forms that reside on my host.

2. The new forms should generally replicate the functionality of the existing form (and I'm open to any suggested improvements)

3. i have a shared web host - [url removed, login to view] but i'm willing to upgrade to a vps if necessary

4. ideally the code would be something i could make small edits to if needed, without having to go to a developer for every small tweak. but this is not a requirement.

5. the forms can be 'stateless' meaning it does not have to have it's own database capturing the inputs.. it just needs to be able to send emails upon submission containing the output in specified format.

6. speed is the absolute highest consideration here, i do not need or want sexy flash or other approaches that impact load time.

7. having said that i would like it to look 'cooler' and possibly take up less room (e.g. smaller row spacing) , and possibly change my wordpress site to have an elastic/dynamic left column width so that when you select a place and the new fields pop out - it resizes automatically (you will see what i mean when you play with the form).

Thank you.

Patrick

FYI OVERVIEW OF THE EXISTING FORM FUNCTIONALITY FOR THE MAIN FORM

1. It has two 'required' field = 'symptoms' and a 'Place'.

2. It cascades selections, so that the most commonly used places show first. (you can test this out, Please don't 'submit' you don't need to )

3. On initial load it does not show all the fields i would like to capture. they only show up after the user makes an initial selection. This is on purpose, i don't want to scare the user off with a scary looking long form.. only shown once they have already made a mental commitment to submit something. (you can test this out, Please don't 'submit' you don't need to ) fyi only about half of the respondents fill out the extra fields.

4. upon submission, it should send following emails

a. an email to my email address

b. a success email to the user (if they entered their email address)

c. an email to zoho creator - (specified email address) where the data is all captured.

d. another email to a second archive database in zoho creator.

e. an email to tweetymail (it compresses it and then tweets it)

OVERVIEW OF THE FUNCTIONALITY FOR THE SURVEY IN THE TOP RIGHT CORNER

1. this is straight forward yes or no survey

2. output is an email to zohocreator

Skills: Electronic Forms, Format & Layout, Website Design, WordPress

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About the Employer:
( 5 reviews ) brooklyn, United States

Project ID: #4023345