Template:Donate file

<_form action="email" recaptcha-v3-action="filedonationform"> <_email template="MediaWiki:FlexForm_filedonation_template"></_email>

<_label for="name">Your name (full name or company)</_label> <_input type="text" id="name" name="name" required="required" placeholder="Your name.."/>

<_label for="email">Email</_label> <_input type="text" id="email" name="email" required="required" placeholder="Your email.."/>

<_label for="address">Address (include country)</_label> <_input type="text" id="address" name="address" required="required" placeholder="Your address.."/>

<_label class="left" for="specialty">Tell us your profession or specialty</_label> <_select name="specialty" class="dropdown" id="specialty" > <_input type="option" value="Please select">Please select</_input> <_input type="option" value="General Practice" selected="_selected">General Practice</_input> <_input type="option" value="Musculoskeletal Medicine">Musculoskeletal Medicine</_input> <_input type="option" value="Other Doctor">Other Doctor</_input> <_input type="option" value="Allied Health">Allied Health</_input> <_input type="option" value="Other health professional">Other health professional</_input> <_input type="option" value="Other (not a health professional)">Other (not a health professional)</_input> <_input type="option" value="Medical student or doctor in training">Medical student or doctor in training</_input> <_input type="option" value="Patient or caregiver">Patient or caregiver</_input> </_select>

<_label for="explanation">Image Explanation</_label> <_input type="textarea" rows="4" id="explanation" name="explanation" required="required" placeholder="Image or file explanation.."/>

<_input type="file" id="file-upload" multiple="multiple" parsecontent target="pictures-[filename]-[mwrandom]" pagecontent="Information for this image: [description]" force="jpg" />

<_input type="submit" value="upload" />

</_form>