Build Filemaker PHP form

I am attaching two screen shots for a new form I would like created. The form must connect to my filemaker database. It is based off of a table called Call Log and their are 28 fields in total that will need to be mapped to the php page. Most of the information is pulled from the database from value lists. I would want the user login information to be an account within Filemaker and will need to interact with Filemakers account authentication. This is a front end that I want to create for our phone answering service. They currently give me all of that information via email. This form is intended to get the information quicker and more standardized by adding it directly to my database.