Simple mobile website with embedded form

First, I need a mobile website that has the following 4 elements (basically it's just a very short survey form):

1. A multiple-choice question

2. An open ended question

3. Ability for the user visiting the site to upload a photo (when clicking a button, it prompts their phone to either i) take a new photo or ii) choose a photo from their library)

4. A 'submit' button so this information is sent

Secondly, I need that information to be databased somehow. Either I can just receive it via email whenever somebody submits the form or it gets databased somewhere where I can access

Lastly, I will want to make different forms with slightly different questions... so I need the site to be easily copied into another page that acts as its own independent survey/form

I attached a short file that shows what I'd like the site to look like, but I"m open to suggestions

This should be an easy project... don't overcomplicate it more than needed & LMK any questions!

Skills: HTML5, jQuery / Prototype, Mobile App Development

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About the Employer:
( 3 reviews ) Brookline, United States

Project ID: #5129926

Awarded to:


What do you mean choose a photo from their library? Where is the library? I'm interested in this job. Thanks.

$157 USD in 3 days
(5 Reviews)

14 freelancers are bidding on average $205 for this job


Hi Dear. I am really happy to get an opportunity to apply to this project. I've read your job description so carefully and finally found out this job is very suitable for my skills and speciality. If you send me me More

$157 USD in 3 days
(12 Reviews)

experts here, ready to start right now. Fluent English and always available on Skyp to discuss project specs. Why waste your time with anyone else? Hello sir, i have checked your project and would like to have you More

$263 USD in 2 days
(56 Reviews)

Dear Sir, We have gone through your requirements. We have professional level expertise driven by experience, professional wisdom and enthusiasm; we offer you cost effectiveness, functionality, the uniqueness of design More

$237 USD in 4 days
(13 Reviews)

Hi, I'm interested to work on your project. Please let me know if you require any detailed information. Waiting for your reply Thanks Dev

$130 USD in 2 days
(17 Reviews)

Hello, I 'm mobile site developer using jquery mobile. please give me more details. ican do this for you. Thanks.

$133 USD in 5 days
(9 Reviews)

We have really experienced in web design and development, Graphic Design and Landing page Design, Logo, Banner, Brochure, HTML, XHTML, [login to view URL] open message board for previous results and let's award us.

$256 USD in 7 days
(6 Reviews)

yes this is an easy project for me see a mobile web portal I designed and developed [login to view URL] [login to view URL] u: admin p: 123456 Are you on skype? phase More

$473 USD in 15 days
(3 Reviews)

Hi, i ready start now. i have read your requirements i am much interested to start this project. i have completed many projects similar to your requirement successfully. thanks Ramcharan

$250 USD in 10 days
(3 Reviews)

We are interested in assisting you in completing your project as we have the experience that is needed. Thank you for reviewing our bid. please download this to your android app developed by us [login to view URL] More

$152 USD in 4 days
(0 Reviews)

Hello Sir, I have good experiences in these kind of work. I can do this job for you ASAP. Please check my feedback and award me the project. Thanks.

$127 USD in 5 days
(0 Reviews)

HI I can do this for you using Jquery Mobile, very good compatible and with a excellent look and feel . i'm ready to start working. Greeting.

$155 USD in 2 days
(0 Reviews)

I am a professional web application developer for past 4 years, who can provide you top quality work on time. I can use a CMS (e.g. Joomla/Drupal/Wordpress) to develop this simple website for you. With CMS, it's easy f More

$222 USD in 3 days
(0 Reviews)

Hi! I'm an experienced web developer located in India and am interested in bidding on your project. My area of expertise is Php,OSCommerce,Drupal, Wordpress,Joomla, Dreamweaver,Flex,Photoshop, Flash,mySql,,Pay More

$155 USD in 5 days
(0 Reviews)