CasperSecurity
<?php
$to = ""; // Your email here
$from = $_REQUEST['email'];
$name = $_REQUEST['name'];
$phone = $_REQUEST['phone'];
$message = $_REQUEST['message'];
$headers = "From: $from";
$subject = "Question Form from Clinic Website";
$fields = array();
$fields{"name"} = "First name";
$fields{"email"} = "Email";
$fields{"phone"} = "Phone";
$fields{"message"} = "Question";
$body = "Here is what was sent:\n\n";
foreach($fields as $a => $b){
$body .= sprintf("%20s:%s\r\n",$b,$_REQUEST[$a]);
}
$send = mail($to, $subject, $body, $headers);
?>