<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
<head>
<title>Contact</title>
<link href="style.css" rel="stylesheet" type="text/css">
<meta http-equiv="content-type" content="text/html; charset=UTF-8">
<?php
$emailadres = "E-mail"; //Hier je e-mail plaatsen
$sitenaam = "Site naam"; //Plaats hier je site
//Niks veranderen aan alles onder dit. Dit script zorgd ervoor dat er automatisch een bericht in je mailbox komt. Dus alles wat wordt verzonden zal in je mailbox komen. Dit werkt echter alleen wanneer je server SMTP heeft.
if(isset($_GET['actie']) == "verzenden")
{
if(empty($_POST['naam']) || empty($_POST['email']) || empty($_POST['bericht']))
{
echo "Je moet wel alle velden invullen!!";
}
else
{
mail($emailadres, $onderwerp, "Afzender: $voornaam $naam \nEmail adres: $email \nIP: ".$_SERVER['REMOTE_ADDR']." \n\nBericht: \n$bericht", "From: $naam || $sitenaam");
echo "Bericht succesvol verzonden!";
}
}
else
{
?>
<!--[if IE]>
<link href="style_ie.css" rel="stylesheet" type="text/css">
<![endif]-->
<style type="text/css">
<!--
.stijl2 {
color: #008C9E;
font-size: 14px;
}
.stijl6 {color: #008C9E; font-size: 14; }
.stijl9 {color: #008C9E; font-size: 14px; font-weight: bold; }
.stijl10 {font-weight: bold}
-->
</style>
</head>
<body>
<div class="dt main" style="background:#7E8993;">
<div class="dr">
<div class="dc">
<div class="dt l1">
<div class="dr">
<div class="dc l1_c1"> <br style="line-height:22px;">
<img src="images/logo.jpg" alt=""><br>
<br style="line-height:23px;">
</div>
<div class="dc l1_c2"> <br style="line-height:44px;">
<form action="" enctype="multipart/form-data" id="f1">
<p>
<input type="text" class="form_1">
<img src="images/spacer.gif" alt="" width="7" height="1">
<input type="image" src="images/h_b1.gif">
<a href="#" class="link1">Uitgebreid zoeken</a></p>
</form>
</div>
</div>
</div>
<div class="dt l2">
<div class="dr">
<div class="dc l2_c1">
<object classid="clsid27CDB6E-AE6D-11cf-96B8-444553540000"
codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=7,0,19,0"
width="526" height="201">
<param name="movie" value="flash/swish_11_02.swf?button=6">
<param name="quality" value="high">
<param name="menu" value="false">
<!--[if !IE]> <-->
<object data="flash/swish_11_02.swf?button=6"
width="526" height="201" type="application/x-shockwave-flash">
<param name="quality" value="high">
<param name="menu" value="false">
<param name="pluginurl" value="http://www.macromedia.com/go/getflashplayer">
FAIL (the browser should render some flash content, not this).
</object>
<!--> <![endif]-->
</object>
<div class="dt l2_c1_t2">
<div class="dr">
<div class="dc"> <img src="images/spacer.gif" alt="" width="1" height="1"><br>
</div>
</div>
</div>
<div class="dt l2_c1_t3">
<div class="dr">
<div class="dc"> <br style="line-height:15px;">
<div style="margin-left:23px;">
<p><span class="txt3">Openingstijden</span><br>
<br style="line-height:16px;">
<img src="images/untitled.jpg" alt="" align="left" style="margin-left:4px; margin-right:20px; margin-top:4px;"><span class="stijl2">maandag t/m donderdag :</span></p>
<p> 8.00 uur tot 12.00 uur</p>
<p>13.00 uur tot 17.00 uur</p>
<p> </p>
<p class="stijl2">vrijdag : </p>
<p>8.00 uur tot 12.00 uur</p>
<p><br style="line-height:25px;">
</p>
<div style="margin-right:8px;">
<div class="dt line2">
<div class="dr">
<div class="dc"> <img src="images/spacer.gif" alt="" width="1" height="6"><br>
</div>
</div>
</div>
</div>
<br style="line-height:10px;">
<div class="dt">
<div class="dr">
<div class="dc p6_t1_c1"> <span class="txt3">Adres</span><br>
<br style="line-height:15px;">
<div style="margin-left:4px;">
<p><span class="stijl9">De Mondenhoek</span><br>
Eursingerweg 3a<br>
9411 BA Beilen<br>
<br style="line-height:20px;">
Tel. 0593 - 541 950<br>
Fax 0593 - 541 949<br>
E-mail : <a href="mailto:info@mondenhoek.nl">info@mondenhoek.nl</a><br>
<br style="line-height:13px;">
<a href="index-8.html" class="link2">Route</a><br>
</p>
</div>
</div>
<div class="dc p6_t1_c2"> <img src="images/spacer.gif" alt="" width="1" height="1"><br>
</div>
<div class="dc p6_t1_c3">
<div style="margin-left:30px;"> <span class="txt3">Afspraak maken?</span><br>
<span class="stijl6"><br style="line-height:15px;">
</span>
<div style="margin-left:4px;">
<p><span class="stijl2" style="color: #008C9E">Tandarts van Zanten:</span><br>
Tel. 0593 - 541 950<br>
<br style="line-height:18px;">
<span class="stijl2">Tandarts van der Zee:</span><br>
Tel. 0593 - 541 704<br>
<br style="line-height:18px;">
<span class="stijl2">Tandarts Schwencke:</span><br>
Tel. 0593 - 541 796</p>
<p> </p>
<p class="stijl2">Tandarts Gresnigt:</p>
<p>Tel. 0593 - 541 796</p>
<h1> </h1>
<p class="stijl2">Tandarts Linde:</p>
<p>Tel. 0593 - 541 796<br>
<br style="line-height:10px;">
</p>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="dc l2_c2"> <img src="images/spacer.gif" alt="" width="1" height="1"><br>
</div>
<div class="dc l2_c3">
<div class="dt p1_t1">
<div class="dr">
<div class="dc"> <br style="line-height:5px;">
<div style="margin-right:5px; margin-left:5px;">
<div class="dt">
<div class="dr">
<div class="dc p1_tt2">
<div style="margin-left:45px;" class="txt1"> <br style="line-height:7px;">
Praktijk gesloten?<br>
<br style="line-height:8px;">
</div>
</div>
</div>
</div>
<br style="line-height:14px;">
<div style="margin-left:22px;">
<p><img src="images/gevel2.jpg" alt="" width="184" height="94"><br>
<br style="line-height:15px;">
Als u buiten onze openingstijden dringend tandheelkundige hulp nodig heeft kunt u bellen met onderstaande telefoonnummers.</p>
<p> U hoort dan op het antwoord-apparaat welke tandarts er dienst heeft in de regio Midden-Drenthe.<br>
<br style="line-height:13px;">
</p>
</div>
</div>
</div>
</div>
</div>
<br style="line-height:2px;">
<div class="dt p2_t1">
<div class="dr">
<div class="dc"> <br style="line-height:4px;">
<div style="margin-right:5px; margin-left:5px;">
<div class="dt">
<div class="dr">
<div class="dc p1_tt1">
<div style="margin-left:40px;" class="txt1"> <br style="line-height:7px;">
Contact formulier<br>
<br style="line-height:10px;">
</div>
</div>
</div>
</div>
</div>
<br style="line-height:8px;">
<div style="margin-left:27px;">
<p>Om u zo goed mogelijk van dienst te zijn vragen wij u onderstaand formulier zo volledig mogelijk in te vullen.<br>
</p>
<form method="post" name="verzenden" action="<?=$_SERVER['PHP_SELF']?>?actie=verzenden">
<table width="266" border="0" bgcolor="#CCCCCC">
<tr>
<td height="16" width="110">Uw Naam:</td>
<td height="16" width="146">
<input type="text" name="naam" size="22"></td>
</tr>
<tr>
<td height="27" width="110">Uw e-mail adres:</td>
<td height="27" width="146">
<input type="text" name="email" size="22"></td>
</tr>
<tr>
<td height="10" colspan="2" align="left"><textarea name="bericht" rows="8" cols="40">Uw Bericht</textarea></td>
</tr>
<tr>
<td height="18" colspan="2" align="left">
<input type="submit" value="Verzenden!" name="verzenden"> <input type="reset" value="Wissen" name="wissen"> </td>
</tr>
</table>
</form>
<?php
}
?>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="dt l3">
<div class="dr">
<div class="dc">
<div style="margin-left:55px;"> <br style="line-height:34px;">
<div class="footerlink footertxt">
<div align="center"><a href="index.html">Welkom</a>|<a href="index-1.html">Praktijk in beeld</a>|<a href="index-2.html">Behandelingen</a>|<a href="index-3.html">Spoedgevallen</a>|<a href="index-9.html">Het team</a>|<a href="index-5.html">Contact </a><br>
</div>
</div>
<div style="margin-left:188px;" class="footerlink2 footertxt">
<div align="center">© 2008 | <a href="index-6.html">Disclaimer</a></div>
</div>
<br style="line-height:30px;">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</body>
</html>
Je kunt de achtergrond nog veranderen van het formulier. Door bij dit
PHP Code: