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