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page_consultation.php
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<!DOCTYPE html>
<html>
<head>
<title>Consultation</title>
<link rel="shortcut icon" type="text/css" href="<?php echo base_url('assets/image/logo.png') ?>">
<style type="text/css">
*{
margin: 0;
padding: 0;
}
body{
background: url('<?php echo base_url('assets/image/11.jpg') ?>') no-repeat;
background-position: center;
background-size: cover;
font-family: sans-serif;
margin-top:100px;
}
.regform{
width: 800px;
background-color: #000;
margin: auto;
color:#FFFFFF;
padding: 10px 0px 10px 0px;
text-align: center;
border-radius: 15px 15px 0px 0px;
}
.main{
background-color: rgb(0,0,0,0.5);
width: 800px;
margin: auto;
}
form{
padding: 10px;
margin-bottom: -5px;
}
#name{
width: 100%;
height: 50px;
}
.name{
margin-left: 25px;
margin-top: 4px;
width: 125px;
color:white;
font-size:18px;
font-weight: 700;
}
.firstname{
position: relative;
left: 200px;
top:-37px;
width: 400px;
line-height: 40px;
border-radius: 6px;
padding: 0 8px;
font-size: 16px;
}
.date{
position: relative;
left: 200px;
top:-37px;
width: 135px;
line-height: 40px;
border-radius: 6px;
padding: 0 5px;
font-size: 16px;
margin-bottom:-10px;
}
.address{
position: relative;
left: 200px;
top:-37px;
width: 450px;
line-height: 40px;
border-radius: 6px;
padding: 0 8px;
font-size: 16px;
margin-bottom:-18px;
}
.email{
position: relative;
left: 200px;
top:-37px;
width: 250px;
line-height: 40px;
border-radius: 6px;
padding: 0 8px;
font-size: 16px;
margin-bottom:-10px;
}
.phone{
position: relative;
left: 200px;
top:-37px;
width: 125px;
line-height: 40px;
border-radius: 6px;
padding: 0 22px;
font-size: 16px;
}
.bttn{
width: 780px;
background-color: #4caf50;
margin: auto;
color:#FFFFFF;
padding: 10px 0px 10px 0px;
text-align: center;
border-radius: 15px 15px 15px 15px;
text-align: center;
}
.btn{
width: 20%;
background:none;
border:2px solid #4caf50;
color:white;
padding: 5px;
font-size: 18px;
cursor: pointer;
margin: 0px 0;
}
.btn:hover{
background-color: #4caf50;
}
</style>
</head>
<body>
<div class="regform"><h3>Patient Data</h3></div>
<div class="main">
<form action="<?php echo base_url(). 'index.php/welcome/consultation_patient'; ?>" method="post">
<?= $this->session->flashdata('info'); ?>
<div id="name">
<h2 class="name">Fullname</h2>
<input class= "firstname"type="text" name="fullname" required><br>
</div>
<h2 class="name">Gender</h2>
<div class="address">
<input type="radio" name="gender" value="male"required>
<label for="male">Male</label>
<input type="radio" id="female" name="gender" value="female"required>
<label for="female">Female</label><br>
</div>
<h2 class="name">Date of Births</h2>
<input class="date"type="date" name="dob" required>
<h2 class="name">Weight</h2>
<input class="email"type="text" name="weight" required>
<h2 class="name">Date of Appointment</h2>
<input class="date"type="date" name="doa" required>
<h2 class="name">Description of Diseases</h2>
<textarea class="address" name="description" rows="3" cols="4" required></textarea><br>
<center><a href="<?php echo base_url('index.php/welcome/pageMenu') ?>" class="btn">Back</a><button class="btn"type="submit">Submit</button></center>
</form>
</div>
</body>
</html>