Form Help

[focus310]

Hello:

I'm hoping someone can point me in the right direction. I want to create a form with PHP so I can then insert the data into a table.

The page of the form is a checklist of behaviors for current and prior.

The form consists of all checkboxes.
The first checkbox identifies the behavior. For example: Abuse
Next to the behavior checkbox, you the current type of behavior. For example: physical, sexual, emotional, etc.
Next to the current type is a set of identical checkboxes which represent the prior behavior.

The form looks something like this. I placed checkmarks so you can see what the form should look like when completed.
Behavior | Current | Prior
[X ] Abuse | [ X] Emotional | [ ] Emotional
| [ ] Physical | [ X] Emotional

[ X] Eating Dis | [ ] Anorexia | [ ] Anorexia
| [ X] Bulimia | [ X] Bulimia


Now I need to collect the results into a database.

Right now, I need help with the design of the form so I can link the current behavior to the type of behavior and link the prior behavior to the type of behavior.

Can someone help me? Thank you in advance.

[Charles]

Start by reading http://www.w3.org/TR/html401/interact/forms.html a couple of times until it makes sense. It should give you pretty much everything that you need.