ok, where i put "spit out form", put this:
<form action="pagename.php" method="post">
<input type="text" name="first_name"><br>
<input type="text" name="last_name"><br>
<input type="text" name="email_address"><br>
<input type="submit" name="send">
</form>
of course you can have as many fields as you want, then in the html part where message = "block of html code", you can simply do this:
$message = "
<html>
<head>
<title></title>
</head>
<body>
First Name: $first_name<br>
Last Name: $last_name<br>
Email Address: $email_address
</body>
</html>
";