location.href='$page'"; } if($_REQUEST['submit']=="Submit"){ $Hosp_Int = implode(', ', $_REQUEST['Hosp_Int']); $Res_Int = implode(', ', $_REQUEST['Res_Int']); $name = $_REQUEST['FName']; $email = $_REQUEST['Email']; $http_referrer = getenv( "HTTP_REFERER" ); $message= '

Name	'.$name.'
Phone	'.$_REQUEST['Phone'].'
Email	'.$email.'
Date Of Birth	'.$_REQUEST['DOB'].'
Please specify what procedure/s you are interested in including dental:	'.$_REQUEST['Question1'].'
How did you find out about CosMediTour?	'.$_REQUEST['Question4'].'

'; // MAIL SUBJECT $subject = "Contact Mail"; // TO MAIL ADDRESS $to="info@cosmeditour.com"; //Normal headers $headers = "From: ".$name."<".$email.">\r\n"; $headers .= "MIME-Version: 1.0\r\n"; $headers .= "Content-Type: text/html; "; $headers .= "\r\n"; // SEND MAIL @mail($to, $subject, $message, $headers); redirect("thankyou.html"); } ?>