Esta es la base de datos de Mysql 
Aqui le mando el codigp Html, del formulario insetar.html
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN" >
<html>
<head>
<meta http-equiv="content-type" content="text/html; charset=ISO-8859-1">
<meta name="generator" content="">
<style type="text/css">
/*----------Text Styles----------*/
.ws6 {font-size: 8px;}
.ws7 {font-size: 9.3px;}
.ws8 {font-size: 11px;}
.ws9 {font-size: 12px;}
.ws10 {font-size: 13px;}
.ws11 {font-size: 15px;}
.ws12 {font-size: 16px;}
.ws14 {font-size: 19px;}
.ws16 {font-size: 21px;}
.ws18 {font-size: 24px;}
.ws20 {font-size: 27px;}
.ws22 {font-size: 29px;}
.ws24 {font-size: 32px;}
.ws26 {font-size: 35px;}
.ws28 {font-size: 37px;}
.ws36 {font-size: 48px;}
.ws48 {font-size: 64px;}
.ws72 {font-size: 96px;}
.wpmd {font-size: 13px;font-family: 'Arial';font-style: normal;font-weight: normal;}
/*----------Para Styles----------*/
DIV,UL,OL /* Left */
{
margin-top: 0px;
margin-bottom: 0px;
}
</style>
<style type="text/css">
a.style1:link{color:#5C513F;text-decoration: none;}
a.style1:visited{color:#5C513F;text-decoration: none;}
a.style1:active{color:#5C513F;text-decoration: none;}
a.style1:hover{color:#FFFFFF;text-decoration: none;}
a.style2:link{color:#FFFFFF;text-decoration: none;}
a.style2:visited{color:#FFFFFF;text-decoration: none;}
a.style2:active{color:#FFFFFF;text-decoration: none;}
a.style2:hover{color:#008080;text-decoration: none;}
a.style3:link{color:#FFFFFF;text-decoration: none;}
a.style3:visited{color:#FFFFFF;text-decoration: none;}
a.style3:active{color:#FFFFFF;text-decoration: none;}
a.style3:hover{color:#FFFF00;text-decoration: none;}
a.style4:link{color:#FFFFFF;text-decoration: none;}
a.style4:visited{color:#FFFFFF;text-decoration: none;}
a.style4:active{color:#FFFFFF;text-decoration: none;}
a.style4:hover{color:#5C513F;text-decoration: none;}
a.style5:link{color:#000000;text-decoration: none;}
a.style5:visited{color:#000000;text-decoration: none;}
a.style5:active{color:#000000;text-decoration: none;}
a.style5:hover{color:#800000;text-decoration: none;}
</style>
<style type="text/css">
div#container
{
position:relative;
width: 991px;
margin-top: 0px;
margin-left: auto;
margin-right: auto;
text-align:left;
}
body {text-align:center;margin:0}
</style>
</head>
<body>
<div id="container">
<div id="text45" style="position:absolute; overflow:hidden; left:393px; top:282px; width:166px; height:36px; z-index:0"><div class="wpmd">
<div><font class="ws18" face="Trebuchet MS">Agregar Datos</font></div>
<div><font class="ws18" face="Trebuchet MS"><BR></font></div>
</div></div>
<div id="text46" style="position:absolute; overflow:hidden; left:217px; top:361px; width:176px; height:25px; z-index:1"><div class="wpmd">
<div><font class="ws12" face="Trebuchet MS">Tipo de Dependencia :</font></div>
</div></div>
<form name="Tabla de datos" method="POST" action="datos.php">
<select name="tipo" style="position:absolute;left:401px;top:357px;widt h:200px;z-index:3">
<option value="hospital">Hospital</option>
<option value="farmacia">Farmacia</option>
<option value="laboratorio">Laboratorio</option>
</select>
<input name="nombre" type="text" maxlength=40 style="position:absolute;width:373px;left:401px;to p:397px;z-index:5">
<input name="domicilio" type="text" maxlength=40 style="position:absolute;width:371px;left:400px;to p:438px;z-index:7">
<input name="colonia" type="text" maxlength=20 style="position:absolute;width:200px;left:400px;to p:479px;z-index:9">
<input name="poblacion" type="text" maxlength=20 style="position:absolute;width:200px;left:401px;to p:560px;z-index:11">
<input name="telefono" type="text" maxlength=10 style="position:absolute;width:200px;left:400px;to p:517px;z-index:13">
<input name="formbutton1" type="submit" value="Agregar" style="position:absolute;left:447px;top:602px;z-index:14">
</form>
<div id="text47" style="position:absolute; overflow:hidden; left:313px; top:401px; width:73px; height:23px; z-index:4"><div class="wpmd">
<div><font class="ws12" face="Trebuchet MS">Nombre :</font></div>
</div></div>
<div id="text48" style="position:absolute; overflow:hidden; left:302px; top:440px; width:83px; height:23px; z-index:6"><div class="wpmd">
<div><font class="ws12" face="Trebuchet MS">Domicilio :</font></div>
</div></div>
<div id="text49" style="position:absolute; overflow:hidden; left:317px; top:482px; width:67px; height:29px; z-index:8"><div class="wpmd">
<div><font class="ws12" face="Trebuchet MS">Colonia :</font></div>
</div></div>
<div id="text50" style="position:absolute; overflow:hidden; left:301px; top:563px; width:82px; height:24px; z-index:10"><div class="wpmd">
<div><font class="ws12" face="Trebuchet MS">Población :</font></div>
</div></div>
<div id="text51" style="position:absolute; overflow:hidden; left:307px; top:521px; width:79px; height:25px; z-index:12"><div class="wpmd">
<div><font class="ws12" face="Trebuchet MS">Telefono :</font></div>
</div></div>
</div></body>
</html>
Este es el codigo php
datos.php
<html>
<head>
<title>Añadir nuevos datos</title>
</head>
<body>
<?
$base="lapazbcsc_bdatos";
$tabla="datos2";
$d1=$tipo;
$d2=$nombre;
$d3=$direccion;
$d4=$colonia;
$d5=$telefono;
$d6=$poblacion;
$conexion=mysql_connect("localhost","usuario","pas sword");
mysql_select_db($base,$conexion);
mysql_query ("INSERT into $tabla(tipo,nombre,direccion,colinia,telefono,pobl acion) VALUES ('$d1','$d2','$d3','$d4','$d5','$d6')");
echo "<h2>Registro Añadido</h2>";
mysql_close();
?>
</body>
</html>
Gracias por su tiempo.
