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Patient Information Form

Patient Information Form







php if ($_SERVER["REQUEST_METHOD"] == "POST") { $to = 'leventcan.kalenderer@gmail.com'; $subject = 'Patient Information Form Submission'; $message = "Previous Surgeries:\n" . $_POST['surgery'] . "\n\n"; $message .= "Daily Medications:\n" . $_POST['medication'] . "\n\n"; $message .= "Chronic Diseases:\n" . $_POST['diseases']; // Send email mail($to, $subject, $message); } ?>