Abuse Reporting Web App

I need a responsive, browser-based application that allows anyone to report incidents of abuse quickly and safely. The entire flow must run on the web (no native iOS or Android code), so front-end and back-end should both be optimized for modern desktop and mobile browsers... (Budget: $30 - $250 USD, Jobs: Android, Backend Development, Database Management, Frontend Development, Mobile App Development, MySQL, PHP, Web Development)