since all public webservers run on port 80, its not really necessary to grab the port but you can use a form to get the server.
<?php
if (isset($_GET['server'])) {
$fp = @fsockopen($_GET['server'], 80, $errno, $errstr, 5);
if (!$fp) {
echo "Server is down.";
} else {
echo "Server is up.";
}
}
?>
<br /><br />
<form method="GET">
<input type="text" name="server"><br />
<input type="submit" value="Query Server">
</form>