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fileasdb.php
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<?php
extract($_POST);
$file_name = "db.txt";
if(isset($submit_r)) {
$new_array = 'array("bloco"=>"'.$blocoid.'", "deficiencia"=>"'.$deftipo.'", "reclamacao"=>"'.$reclamacaotext.'"),';
$current = file_get_contents($file_name);
$current .= $new_array;
file_put_contents($file_name, $current);
}
?>
<!DOCTYPE html>
<html>
<head>
<title>Ouvidoria - Universidade Federal de Alagoas</title>
</head>
<body>
<style>
input,textarea{width:350px; height: 150px}
input[type=submit]{width:150px; height: 30px}
</style>
<div align="center">
<form method="POST">
<table width="250" border="0">
<tr>
<td>
<select name="blocoid">
<option>Bloco 1</option>
<option>Bloco 2</option>
<option>Bloco 3</option>
<option>Bloco 4</option>
<option>Bloco 5</option>
<option>Bloco 6</option>
<option>Bloco 7</option>
</select>
</td>
</tr>
<tr>
<td>
<select name="deftipo">
<option>Amputação</option>
<option>Hemiparesia</option>
<option>Hemiplegia</option>
<option>Monoparesia</option>
<option>Monoplegia</option>
<option>Ostomia</option>
<option>Paralisia Cerebral</option>
<option>Paraparesia</option>
<option>Paraplegia</option>
<option>Tetraparesia</option>
<option>Tetraplegia</option>
<option>Triparesia</option>
<option>Triplegia</option>
</select>
</td>
</tr>
<tr>
<td><textarea placeholder="Reclamação..." name="reclamacaotext"></textarea></td>
</tr>
<tr>
<td align="center">
<input type="submit" value="Enviar Reclamação" name="submit_r">
</td>
</tr>
</table>
</form>
</div>
</body>
</html>