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randell |
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<?php
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$config = json_decode(file_get_contents('config.json'), true);
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// if we have success in the query string, display a success message
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if (isset($_GET['success']) && $_GET['success'] == 1) {
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// Create a variable to hold the success message
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$success_message = "Your workstation request has been submitted successfully.";
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}
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else {
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// If no success, set the message to an empty string
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$success_message = "";
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}
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// if there is an error in the query string, display an error message
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if (isset($_GET['error'])) {
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$error_message = "There was an error submitting your request. Please try again.";
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} else {
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$error_message = "";
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}
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?>
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<!DOCTYPE html>
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<html>
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<head>
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<meta charset="UTF-8">
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<title>MedCAD Workstation Build Out</title>
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<link rel="stylesheet" href="style.css">
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</head>
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<body>
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<form method="POST" action="send.php">
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<?php if (isset($success_message)): ?>
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<div class="success-message"><?= htmlspecialchars($success_message) ?></div>
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<?php endif; ?>
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<?php if (isset($_GET['error'])): ?>
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<div class="error-message">There was an error submitting your request. Please try again.</div>
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<?php endif; ?>
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<h2>MedCAD Workstation Build Out</h2>
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<label for="requestor">Requestor Name</label>
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<input type="text" name="requestor" required>
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<label for="requestor_email">Requestor Email</label>
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<input type="email" name="requestor_email" required>
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<label for="workstation">Workstation Name</label>
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<input type="text" name="workstation">
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<label for="username">User Name</label>
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<input type="text" name="username">
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<label for="remote_access">Remote Access</label>
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<select name="remote_access">
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<?php foreach ($config['remote_access'] as $option): ?>
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<option value="<?= htmlspecialchars($option) ?>"><?= htmlspecialchars($option) ?></option>
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<?php endforeach; ?>
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</select>
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<label>Software List</label>
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<?php foreach ($config['software'] as $software): ?>
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<input type="checkbox" name="software[]" value="<?= htmlspecialchars($software) ?>">
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<?= htmlspecialchars($software) ?><br>
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<?php endforeach; ?>
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<label for="notes">Notes</label>
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<textarea name="notes"></textarea>
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<button type="submit">Submit</button>
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</form>
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</body>
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</html>
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