Website feedback form - Standalone form (PHP, MySQL)

This project is for the development of a feedback form as attached in the screenshot. Our backend environment is: - Ubuntu Server 20.04 LTS - Apache - PHP - MySQL The flow: 1) Customers will be sent a URL to the form, with query parameters used for identification. For example: [login to view URL] 2) Customers are shown the form, they can fill out the two questions (neither are mandatory) 3) Customer clicks the send button, which initiates a POST request where this information is inserted into the MySQL database "Feedback" table "Responses" Record ID, DateTime, IP Address, Agent, Ticket, Channel, Question 1, Question 2 Record ID - Auto-Increment DateTime - Sydney Time IP Address - of user Agent - From origin URL query parameter Ticket - From origin URL query parameter Channel - From origin URL query parameter Question 1 - either "1" or "2" based on selection Question 2 - the text of question 2 All fields, regardless of origin, need to be filtered safely prepared before inserting into MySQL. If the same IP has >3 results from the same day, then do not insert the new information into MySQL (skip). 4) Customer is served a "Thank you for your feedback, we are always exploring how to improve." Preferably no JS; just HTML5/CSS. Though a good-looking form and thank you page are needed.