-
Notifications
You must be signed in to change notification settings - Fork 0
/
hi.php
55 lines (55 loc) · 3.13 KB
/
hi.php
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Doctor Register</title>
<link rel="stylesheet" href="css/styles.css">
</head>
<body>
<div class="container">
<div class="card">
<div class="inner-box" id="card">
<div class="card-back">
<h2>Doctor Register</h2>
<form action="doctor_register.php" method="POST">
<input type="text" name="name" placeholder="Full Name" required>
<input type="date" name="dob" placeholder="Date of Birth" required>
<select name="gender" required>
<option value="" disabled selected>Select Gender</option>
<option value="male">Male</option>
<option value="female">Female</option>
</select>
<input type="text" name="nic" placeholder="NIC" required>
<input type="text" name="address" placeholder="Address" required>
<input type="text" name="phone" placeholder="Phone Number" required>
<input type="email" name="email" value="<?php echo $_SESSION['email']; ?>" readonly required>
<input type="password" name="password" placeholder="Password" required>
<input type="password" name="confirm_password" placeholder="Confirm Password" required>
<input type="text" name="medical_number" placeholder="Medical License Number" required>
<input type="text" name="work_place" placeholder="Work Place (Hospital)" required>
<input type="text" name="experience" placeholder="Experience" required>
<input type="text" name="other_qualification" placeholder="Other Qualification" required>
<h3>Availability</h3>
<select name="available_hours" required>
<option value="" disabled selected>Select Available Hours</option>
<option value="morning">Morning</option>
<option value="afternoon">Afternoon</option>
<option value="evening">Evening</option>
</select>
<select name="preferred_location" required>
<option value="" disabled selected>Select Preferred Location</option>
<option value="location1">Location 1</option>
<option value="location2">Location 2</option>
<option value="location3">Location 3</option>
</select>
<button type="submit">Register</button>
</form>
<button id="open-login">Login</button>
</div>
</div>
</div>
</div>
<script src="js/scripts.js"></script>
</body>
</html>