Form Fields Not Being Passed - php

Question

Can some help me with the form on this page: http://riccipsych.com/referrals.php? The form fields are not being passed to the form handler: http://riccipsych.com/sendmail.php. I'm getting an email from my form with all the form labels but, the fields are blank.
Here's the code for each page:
referrals.php
<p><?php
$ipi = getenv("REMOTE_ADDR");
$httprefi = getenv ("HTTP_REFERER");
$httpagenti = getenv ("HTTP_USER_AGENT");
?>
<input type="hidden" name="ip" value="<?php echo $ipi ?>" />
<input type="hidden" name="httpref" value="<?php echo $httprefi ?>" />
<input type="hidden" name="httpagent" value="<?php echo $httpagenti ?>" /></p>
<form method="post" action="sendmail.php">
<h3>Client Information:</h3>
<label for="attn" class="label">Referral To:</label>
<select id="attn" name="select">
<option value="General">General</option>
<option value="Dr. Tammie Ricci, C.Psych.">Dr. Tammie Ricci, C.Psych.</option>
<option value="Dr. Paul Mendella, C.Psych.">Dr. Paul Mendella, C.Psych.</option>
<option value="Dr. Paul Roy, Psychiatrist">Dr. Paul Roy, Psychiatrist</option>
</select>
<br />
<label for="cname" class="label">Client Name:</label>
<input id="cname" type="text" name="textfield" maxlength="60">
<br />
<label for="caddress" class="label">Client Address:</label>
<input id="caddress" type="text" name="textfield" maxlength="60">
<br />
<label for="ccity" class="label">Client City:</label>
<input id="ccity" type="text" name="textfield" maxlength="50">
<br />
<label for="cprovince" class="label">Client Province:</label>
<select id="cprovince" name="select">
<option value="NFLD">NFLD </option>
<option value="NS">NS </option>
<option value="PEI">PEI </option>
<option value="NB">NB </option>
<option value="PQ">PQ </option>
<option value="ON">ONT </option>
<option value="MAN">MAN </option>
<option value="SASK">SASK </option>
<option value="ALTA">ALTA </option>
<option value="BC">BC </option>
<option value="YT">YT </option>
<option value="NWT">NWT </option>
<option value="NVT">NVT </option>
</select>
<br />
<label for="cpcode" class="label">Client Postal Code:</label>
<input id="cpcode" type="text" name="textfield" maxlength="7">
<br />
<label for="chphone" class="label">Client Home Phone:</label>
<input id="chphone" type="text" name="textfield" maxlength="15">
<br />
<label for="cwphone" class="label">Client Work Phone:</label>
<input id="cwphone" type="text" name="textfield" maxlength="15">
<br />
<label for="ccphone" class="label">Client Cell Phone:</label>
<input id="ccphone" type="text" name="textfield" maxlength="15">
<br />
<label for="cdob" class="label">Client Date of Birth</label>
<input id="cdob" type="text" name="textfield" maxlength="20">
<br />
<label for="chmessage" class="label">Can we leave a message at the client's home?</label>
<select id="chmessage" name="select">
<option value="Yes">Yes </option>
<option value="No">No </option>
</select>
<br />
<label for="cwmessage" class="label">Can we leave a message at the client's workplace?</label>
<select id="cwmessage" name="select">
<option value="Yes">Yes </option>
<option value="No">No </option>
</select>
<br />
<br />
<h3>Referral Information</h3>
<label for="rname" class="label">Referral Name:</label>
<input id="rname" type="text" name="textfield" maxlength="60">
<br />
<label for="raddress" class="label">Referral Address:</label>
<input id="raddress" type="text" name="textfield" maxlength="60">
<br />
<label for="rcity" class="label">Referral City:</label>
<input id="rcity" type="text" name="textfield" maxlength="50">
<br />
<label for="rprovince" class="label">Referral Province:</label>
<select id="rprovince" name="select">
<option value="NFLD">NFLD </option>
<option value="NS">NS </option>
<option value="PEI">PEI </option>
<option value="NB">NB </option>
<option value="PQ">PQ </option>
<option value="ON">ONT </option>
<option value="MAN">MAN </option>
<option value="SASK">SASK </option>
<option value="ALTA">ALTA </option>
<option value="BC">BC </option>
<option value="YT">YT </option>
<option value="NWT">NWT </option>
<option value="NVT">NVT </option>
</select>
<br />
<label for="rpcode" class="label">Referral Postal Code:</label>
<input id="rpcode" type="text" name="textfield" maxlength="7">
<br />
<label for="rwphone" class="label">Referral Work Phone:</label>
<input id="rwphone" type="text" name="textfield" maxlength="15">
<br />
<label for="remail" class="label">Referral E-Mail:</label>
<input id="remail" type="text" name="textfield" maxlength="80">
<br />
<label for="notes" class="label">Notes:</label>
<textarea id="notes" style="width: 300px; height: 150px;" name="textarea"></textarea>
<br />
<br />
<p><input type="submit" value="Send Form" /></p>
sendmail.php
<?php
if(!$remail == "" && (!strstr($remail,"#") || !strstr($remail,".")))
{
echo "<h2>Use Back - Enter valid e-mail</h2>\n";
$badinput = "<h2>Feedback was NOT submitted</h2>\n";
echo $badinput;
}
if(empty($rname) || empty($remail) || empty($cname )) {
echo "<h2>Use Back - fill in all fields</h2>\n";
}
$todayis = date("l, F j, Y, g:i a") ;
$attn = $attn ;
$subject = $attn;
$notes = stripcslashes($notes);
$message = " $todayis [EST] \n
Referral To: $attn \n
Client Name: $cname \n
Client Address: $caddress \n
Client City: $ccity \n
Client Province: $cprovince \n
Client Postal Code: $cpcode \n
Client Home Phone: $chphone \n
Client Work Phone: $cwphone \n
Client Cell Phone: $ccphone \n
Client Date of Birth: $cdob \n
Leave Message at Client's Home: $chmessage \n
Leave Message at Client's Workplace: $chmessage \n
Referral Name: $rname \n
Referral Address: $raddress \n
Referral City: $rcity \n
Referral Province: $rprovince \n
Referral Postal Code: $rpcode \n
Referral Work Phone: $rwphone \n
Referral Email: $remail \n
Notes: $notes \n
From: $rname ($remail)\n
Additional Info : IP = $ip \n
Browser Info: $httpagent \n
Referral : $httpref \n
";
$from = "From: $remail\r\n";
mail("info#riccipsych.com", $subject, $message, $from);
?>
<h1>Thank You</h1>
<p>Thank you for submitting your referral. We will contact you shortly.</p>
It is still not working. I changed sendmail.php to sendeail.php and added:
<?php
$ip = $_POST['ip'];
$httpref = $_POST['httpref'];
$httpagent = $_POST['httpagent'];
$attn = $_POST['attn'];
$cname = $_POST['cname'];
$caddress = $_POST['caddress'];
$ccity = $_POST['ccity'];
$cprovince = $_POST['cprovince'];
$cpcode = $_POST['cpcode'];
$chphone = $_POST['chphone'];
$cwphone = $_POST['cwphone'];
$ccphone = $_POST['ccphone'];
$cdob = $_POST['cdob'];
$chmessage = $_POST['chmessage'];
$cwmessage = $_POST['cwmessage'];
$rname = $_POST['rname'];
$raddress = $_POST['raddress'];
$rcity = $_POST['rcity'];
$rprovince = $_POST['rprovince'];
$rpcode = $_POST['rpcode'];
$rwphone = $_POST['rwphone'];
$remail = $_POST['remail'];
$notes = $_POST['notes'];
if(!$remail == "" && (!strstr($remail,"#") || !strstr($remail,".")))
{
echo "<h2>Use Back - Enter valid e-mail</h2>\n";
$badinput = "<h2>Feedback was NOT submitted</h2>\n";
echo $badinput;
}
if(empty($rname) || empty($remail) || empty($cname )) {
echo "<h2>Use Back - fill in all fields</h2>\n";
}
$todayis = date("l, F j, Y, g:i a") ;
$attn = $attn ;
$subject = $attn;
$notes = stripcslashes($notes);
$message = " $todayis [EST] \n
Referral To: $attn \n
Client Name: $cname \n
Client Address: $caddress \n
Client City: $ccity \n
Client Province: $cprovince \n
Client Postal Code: $cpcode \n
Client Home Phone: $chphone \n
Client Work Phone: $cwphone \n
Client Cell Phone: $ccphone \n
Client Date of Birth: $cdob \n
Leave Message at Client's Home: $chmessage \n
Leave Message at Client's Workplace: $chmessage \n
Referral Name: $rname \n
Referral Address: $raddress \n
Referral City: $rcity \n
Referral Province: $rprovince \n
Referral Postal Code: $rpcode \n
Referral Work Phone: $rwphone \n
Referral Email: $remail \n
Notes: $notes \n
From: $rname ($remail)\n
Additional Info : IP = $ip \n
Browser Info: $httpagent \n
Referral : $httpref \n
";
$from = "From: $remail\r\n";
mail("info#riccipsych.com", $subject, $message, $from);
?>
<h1>Thank You</h1>
<p>Thank you for submitting your referral. We will contact you shortly.</p>

Answer 1

You need to define your variables in sendmail.php with $_POST or $_REQUEST:
$remail = $_REQUEST['remail'];
To see what variables you have, you can also use the following code on sendmail.php
foreach($_REQUEST as $k => $v)
echo "$k = $v\n";