Appointment Request System

Appointment Request System
Hello,
we have to set up an appointment system for a nonprofit organization where users should ask for a medical appointment. Is not like an hotel booking system, this not require an availibilty or a calendar. How should works:

Public section:
1) user see a list of services, like dentists, blood donations, ecc.
2) user click on one of the service and see a list of city where this service is available
3) user click on a city and should fill the form
4) the form must have fields like: name, surname, address, phone, email, privacy acceptance (required fields) and other optional fields (health id card, a text note field), and a simple captcha. And with error messages system while compiling the form.
5) when the form is filled and sent, an email should be sent both to user and to admin

Admin section:
1) all appointments requested should be stored into a table that could be printed (or exported). The requests should be ordered by name, or by date or by city.
2) more operators should login to the admin area
3) in this table, admins/operators should have a field where they should update the status of the request: the operator should select from 2 status ( “to do” -default- or “done”) and put a text note. If the operator “john” change the status, a column will show “status changed by john on date..)

Some notes:
This administration will be used by volunteers that do not have an high pc skill, so easy use is required
Hosting: linux, with mysql
After some test, maybe the volunteers should ask for some little improvements at the script. I remember you: is a non profit organization and this system should help the volunteers, so an easy administration is required and.. please do not ask high prices 🙂

For any question do not hesitate to ask
Thanks

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