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doc-apt.php
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<?php include('security.php'); ?>
<?php include('includes/header.php');?>
<?php include('includes/navbar.php');?>
<link rel="stylesheet" href="css/doc.css">
<!-- <link rel="stylesheet" href="css/responsive.css"> -->
</head>
<style type="text/css">
body{
background-color: #DA2A47;
}
</style>
<!-- header-start -->
<br><br><br><br>
<div class="container register" >
<div class="row">
<div class="col-md-3 register-left">
<img src="img/icons/healthcare-and-medical (3).png" alt=""/>
<h3 style="color: black;">Doctor's Appointment</h3>
</div>
<div class="col-md-9 register-right" style="background-color: #FFC7C9;">
<ul class="nav nav-tabs nav-justified" id="myTab" role="tablist" style="background-color: #E7717D;">
<li class="nav-item">
<a class="nav-link active" id="home-tab" data-toggle="tab" href="#home" role="tab" aria-controls="home" aria-selected="true" style="color: black;">Patient</a>
</li>
<li class="nav-item">
<a class="nav-link" id="profile-tab" data-toggle="tab" href="#profile" role="tab" aria-controls="profile" aria-selected="false" style="color: black;">Doctor</a>
</li>
</ul>
<div class="tab-content" id="myTabContent">
<div class="tab-pane fade show active" id="home" role="tabpanel" aria-labelledby="home-tab">
<h3 class="register-heading">Patients Personal Details </h3>
<form action="code-patients.php" action="POST">
<div class="row register-form">
<div class="col-md-12">
<p>Fill the form below indicating the appoitment type you need. We will get back soon to you for more updates.</p>
<div class="form-group">
<input type="text" class="form-control" placeholder="Full Name" value="" required="" name="name" />
</div>
<div class="form-group">
<input type="text" class="form-control" placeholder="Address" name="address" value="" />
</div>
<div class="col-md-6">
<div class="form-group">
<input type="text" class="form-control" placeholder="Age" value="" name="age"/>
</div>
<div class="form-group">
<input type="text" class="form-control" placeholder="Phone Number" value="" name="contact"/>
</div>
<div class="form-group">
<input type="text" class="form-control" placeholder="Email" value="" name="email" />
</div>
<select name="state" class="form-control" required="" >
<option>Select State</option>
<option name="state" value="andhra pradesh "> Andhra Pradesh</option>
<option name="state" value="arunachal pradesh " > Arunachal Pradesh </option>
<option name="state" value="assam " > Assam </option>
<option name="state" value="bihar " > Bihar </option>
<option name="state" value="chhattisgarh " > Chhattisgarh </option>
<option name="state" value="goa " > Goa </option>
<option name="state" value="gujarat " > Gujarat </option>
<option name="state" value="haryana " > Haryana </option>
<option name="state" value="himachal pradesh " > Himachal Pradesh </option>
<option name="state" value="jammu & kashmir " > Jammu & Kashmir </option>
<option name="state" value="jharkhand" > Jharkhand</option>
<option name="state" value="karnataka " > Karnataka </option>
<option name="state" value="kerala " > Kerala </option>
<option name="state" value="madhya pradesh " > Madhya Pradesh </option>
<option name="state" value="maharashtra " > Maharashtra </option>
<option name="state" value="manipur " > Manipur </option>
<option name="state" value="meghalaya " > Meghalaya </option>
<option name="state" value="mizoram " > Mizoram </option>
<option name="state" value="nagaland " > Nagaland </option>
<option name="state" value="orissa " > Orissa </option>
<option name="state" value="punjab " > Punjab </option>
<option name="state" value="rajasthan " > Rajasthan </option>
<option name="state" value="sikkim " > Sikkim </option>
<option name="state" value="tamil nadu " > Tamil Nadu </option>
<option name="state" value="telangana " > Telangana </option>
<option name="state" value="tripura " > Tripura </option>
<option name="state" value="uttar pradesh " > Uttar Pradesh </option>
<option name="state" value="uttarakhand " > Uttarakhand </option>
<option name="state" value="west bengal " > West Bengal </option>
<option name="state" value="andaman & nicobar islands " > Andaman & Nicobar Islands </option>
<option name="state" value="dadra and nagar haveli" > Dadra and Nagar Haveli</option>
<option name="state" value="daman and diu" > Daman and Diu</option>
<option name="state" value="lakshadweep " > Lakshadweep </option>
<option name="state" value="puducherry " > Puducherry </option>
<option name="state" value="delhi " > Delhi </option>
<option name="state" value="chandigarh " > Chandigarh </option>
</select>
</div>
<h3>Appointment Details</h3>
<p>Which type of appointment you require </p>
<div class="form-group">
<div class="maxl">
<input type="text" class="form-control" placeholder="Type Of Appointment" value="" name="apt" />
</div>
</div>
<div class="col-md-8">
<p>Appoitnment Date</p>
<div class="form-group">
<input type="date" class="form-control" placeholder="Date" value="" name="date" />
</div>
</div>
</div>
<div class="col-md-12">
<button name="Patients_btn" type="submit" class="btnRegister" value="Register" style="background-color: #E7717D; color: black; ">Submit</button>
</div>
</form>
</div>
</div>
<div class="tab-pane fade show" id="profile" role="tabpanel" aria-labelledby="profile-tab">
<h3 class="register-heading">Doctor's Registration</h3>
<form action="code-doc-apt.php" action="POST">
<div class="row register-form">
<div class="col-md-6">
<div class="form-group">
<input type="text" class="form-control" placeholder="Full Name *" value="" name="fullname"/>
</div>
<div class="form-group">
<input type="email" class="form-control" placeholder="Email *" value="" name="email"/>
</div>
<div class="form-group">
<input type="text" maxlength="10" minlength="10" class="form-control" placeholder="Phone *" value="" name="phone"/>
</div>
</div>
<div class="col-md-12">
<div class="form-group">
<input type="password" class="form-control" placeholder="Doctor's License No." value="" name="license"/>
</div>
<div class="form-group">
<input type="text" class="form-control" placeholder="Address" value="" name="address"/>
</div>
<select name="state" class="form-control" required="" >
<option>Select State</option>
<option name="state" value="andhra pradesh "> Andhra Pradesh</option>
<option name="state" value="arunachal pradesh " > Arunachal Pradesh </option>
<option name="state" value="assam " > Assam </option>
<option name="state" value="bihar " > Bihar </option>
<option name="state" value="chhattisgarh " > Chhattisgarh </option>
<option name="state" value="goa " > Goa </option>
<option name="state" value="gujarat " > Gujarat </option>
<option name="state" value="haryana " > Haryana </option>
<option name="state" value="himachal pradesh " > Himachal Pradesh </option>
<option name="state" value="jammu & kashmir " > Jammu & Kashmir </option>
<option name="state" value="jharkhand" > Jharkhand</option>
<option name="state" value="karnataka " > Karnataka </option>
<option name="state" value="kerala " > Kerala </option>
<option name="state" value="madhya pradesh " > Madhya Pradesh </option>
<option name="state" value="maharashtra " > Maharashtra </option>
<option name="state" value="manipur " > Manipur </option>
<option name="state" value="meghalaya " > Meghalaya </option>
<option name="state" value="mizoram " > Mizoram </option>
<option name="state" value="nagaland " > Nagaland </option>
<option name="state" value="orissa " > Orissa </option>
<option name="state" value="punjab " > Punjab </option>
<option name="state" value="rajasthan " > Rajasthan </option>
<option name="state" value="sikkim " > Sikkim </option>
<option name="state" value="tamil nadu " > Tamil Nadu </option>
<option name="state" value="telangana " > Telangana </option>
<option name="state" value="tripura " > Tripura </option>
<option name="state" value="uttar pradesh " > Uttar Pradesh </option>
<option name="state" value="uttarakhand " > Uttarakhand </option>
<option name="state" value="west bengal " > West Bengal </option>
<option name="state" value="andaman & nicobar islands " > Andaman & Nicobar Islands </option>
<option name="state" value="dadra and nagar haveli" > Dadra and Nagar Haveli</option>
<option name="state" value="daman and diu" > Daman and Diu</option>
<option name="state" value="lakshadweep " > Lakshadweep </option>
<option name="state" value="puducherry " > Puducherry </option>
<option name="state" value="delhi " > Delhi </option>
<option name="state" value="chandigarh " > Chandigarh </option>
</select>
<br>
<div class="form-group">
<select class="form-control" name="timings">
<option class="hidden" selected disabled>Timings you will be able to serve</option>
<option name="24 Hours">24 Hours</option>
<option name="10AM-5PM">10 AM - 5 PM</option>
</select>
</div>
<button type="submit" class="btnRegister" name="doc_apt_btn" value="Register" style="background-color: #E7717D; color: black;">Submit</button>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
</div>
<br><br><br><br>
<?php include('includes/scripts.php');?>
<?php include('includes/footer.php');?>