Design Help

[focus310]

Hello:

I have a form which appears as the image that is attached. I need to get the results of the form into a table. I am having great difficulty.

I have two tables.
Current
current_id
client_id
name
current

Prior
prior_id
client_id
name
prior

I attempted the following. I created the checkboxes as arrays, behavior[], current[], and prior[]. The insert didn't work correctly. I can't even begin to describe what the result of the insert query was.

Does anyone have any ideas on how I can proceed to capture the data from this form?

Thanks for the help.