I'm a complete noob to php and trying to fix a contact form for work. This page needs two contact forms: http://moschettalaw.com/fda-study-li...ladder-cancer/,
I'm dealing with the bottom one currently. Any help is tremendously appreciated. I'm getting my contact emails back from tests, but several of the fields are empty. Site is in Wordpress.


HTML:
HTML Code:
<h2>Actos® Bladder Cancer Contact Form</h2>
<form id="bladder-cancer-form" action="/forms/mail2.php" enctype="multipart/form-data" method="post"><label>Name:</label>&nbsp;

<input id="formname" name="formname" type="text" /> <label>
Phone:</label>&nbsp;

<input id="formphone" name="formphone" type="text" /></form> <form action="/forms/mail2.php" enctype="multipart/form-data" method="post"><label>Email:</label>&nbsp;

<input id="formemail" name="formemail" type="email" /></form> <form action="/forms/mail2.php" enctype="multipart/form-data" method="post"><label>How Long Were You Taking Actos?®</label>&nbsp;

<input id="formhowlong" name="formhowlong" type="text" /></form> <form action="/forms/mail2.php" enctype="multipart/form-data" method="post"><label>Where you Diagnosed with Bladder Cancer?</label>&nbsp;

Yes:
<input name="formdiagnosed" type="radio" value="Yes" />

No:
<input name="formdiagnosed" type="radio" value="No" />

<label>Date of Diagnosis</label>

<input id="formdate" name="formdate" type="text" /> <label></label> <label> </label>&nbsp;

<label>Questions:</label>
<textarea id="formquestions" style="width: 310px; height: 152px; margin: 2px;" name="formquestions"></textarea>
For immediate assistance please call us at: 1-877-472-1578 Toll Free 724-225-3060 Local in PA

<input class="submit" name="submit" type="submit" value="Submit" /> </form>
PHP:
PHP Code:
<?

if(isset($_POST['submit'])) {
        
$to         "michael@piconsulting.com";
        
$subject    "Bladder Cancer Form";
        
$headers    "From: $formemail";
        
}


        
$formname        $_POST['formname'];
        
$formphone        $_POST['formphone'];
        
$formemail        $_POST['formemail'];
        
$formhowlong    $_POST['formhowlong'];
        
$formdiagnosed    $_POST['formdiagnosed'];
        
$formdate        $_POST['formdate'];
        
$formquestions    $_POST['formquestions'];
        
        
$referer    $_SERVER[HTTP_REFERER];
        
$ip         $_SERVER[REMOTE_ADDR];

        

        
$msg       .= "Name: $formname\n";
        
$msg       .= "Phone: $formphone\n";
        
$msg       .= "Email: $formemail\n";
        
$msg       .= "Response: \n";
        
$msg       .= "Took Actos How Long: $formhowlong\n";  
        
$msg       .= "Diagnosed?: $formdiagnosed\n"
        
$msg       .= "Date of Diagnosis: $formdate\n"
        
$msg       .= "Question: $formquestions\n\n"
        
        
$msg       .= "Referer: $referer \n";
        
$msg       .= "IP Address: $ip \n";

        
mail($to$subject$msg$headers); 
        
        
header ("Location:/thank-you/");
    

?>