collection of data with online form

Completado Publicado Jun 5, 2009 Pagado a la entrega
Completado Pagado a la entrega

I need a online-questionaire on my homepage. the information, that is filled in should be exported in excel or an excel-compatible database.

the clients get an email with a link to my homepage. Than they select over a scroll down menu which company they work for (I have to be able to edit/add companies there). afterwards they are linked to an online questionaire, give there contacts (name, address, date of birth, insurance company) and answer some multiple-choice-questions. then they click on a button (submit) and the information then should be saved in a data-base. transfer has to bee ssl-secure

## Deliverables

The best to start is probably to go to my hp [url removed, login to view] In the same design I need a online questionaire (index-file in attachment). Clients follow a link in an e-mail and first of all select on a seperate page over a scroll down menu, which company they belong to. I should be able to edit/ add the companies shown in the scroll down menu. afterwars they are forwarded to a qustionaire (always the same, no matter where they work; the information where they work just has to be exported to the database).

After two headlines:

"Darmkrebsvorsorge" and

"Fragebogen zur Vorabklärung"

a short text is following:

"Willkommen im Darmkrebsprogramm der KME. Bitte füllen Sie den Fragebogen vollständig aus. Wir informieren Sie in den nächsten Tagen, wie hoch ihr Darmkrebsrisiko ist. Ihre Daten werden verschlüsselt an uns gesendet und unterliegen dem Datenschutz"

Then the questionaire follows.

They fill in first name (Vorname), second name (Nachname), date of birth (Geburtsdatum), street (Strasse) Zip-code (PLZ), city (Stadt), phone-number (area code (Vorwahl) and number (Rufnummer) seperate), e-mail (E-Mail) and insurance company (Krankenkasse). The form should be in german, so I wrote the translation behind in brackets.

Then the user has to answer 11 questions with yes or no.

If he answers question 2 with yes, he should additionally be asked a further question he can select out of three answers. If question 9 is answered with yes, the user has to write a year into a box. question 10 has five subquestions, which can be answered with yes or no. I will attach the offline questionaire for the questions and that you better unterstand what I mean.

between the last question and the submit buttom, two further sentences should appear. The first should be marked but the user can demark it, the second should be demarked, but can be marked and this should be exported as well.

first sentence:

"Ich bin damit einverstanden, dass mich die SBK über weitere Präventionsangebote informiert."

second sentence:

"Ich möchte in jedem Fall einen Darmkrebstest machen, auch wenn ich zu keiner Risikogruppe gehöre."

when I add a new company on the first site, I should be able to select if and which of this sentences appear

All data shoulld be exported to a data-base. I have to be able to select the database for the several informations. Most important is to sort according to company. The data should be able to be exported into excel.

The data transfer schould be ssl-secured

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