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appointment.html
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appointment.html
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<!DOCTYPE html>
<html lang="en">
<head>
<link rel="stylesheet" href="appointment.css">
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Appointment</title>
</head>
<body>
<div id="book">
<h1><u><strong>Appointment Form</strong></u></h1>
<form action="bookappointment.php" method="post">
<input type="text" name="name" placeholder="Enter your name" required>
<input type="text" name="phoneNo" placeholder="Enter your phone number" required>
<input type="text" name="mail" placeholder="Enter your mail" required>
<p>Please select your gender : </p>
<p> Male</p><input type="radio" name="Gender" class="gen" value="Male">
<p> Female</p><input type="radio" name="Gender" class="gen" value="Female">
<p> Other</p><input type="radio" name="Gender" class="gen" value="Other">
<br>
<label for="select"> Select your doctor : </label>
<select name="Doctor" id="select">
<option value="Anand Joshi">Anand Joshi</option>
<option value="Yogesh Sharma">Yogesh Sharma</option>
<option value="Amol Yadav">Amol Yadav</option>
<option value="Sarawati Mohite">Sarawati Mohite</option>
</select>
<br>
<label for="problem"> Select your problem : </label>
<select name="problem" id="problem">
<option value="Diabetes">Diabetes</option>
<option value="Cancer">Cancer</option>
<option value="Heart diseases">Heart diseases</option>
<option value="Influenza">Influenza</option>
<option value="Other">Other</option>
</select>
<br>
<label for="mode"> Mode of Conduct: </label>
<select name="conduct" id="conduct">
<option value="Online">Online</option>
<option value="Offline">Offline</option>
</select>
<br>
<label for="start">Select Preffered date:</label>
<script type="text/javascript">
var today = new Date();
var day = today.getDay();
var date = today.getFullYear()+'-'+(today.getMonth()+1)+'-'+today.getDate();
var month = new Month();
var currmonth = today.getMonth();
var nextmonth = today.getMonth()+4;
</script>
<input type="date" id="date" name="date" value="Select Preffered Date" placeholder="Select Preffered Date" min="2022-01-06" max="2022-12-31">
<label for="timing">Select your timing slot : </label>
<select name="time" id="timing">
<option value="10.00 - 12.00">10.00 - 12.00 AM</option>
<option value="2.00 - 5.00">2.00 - 5.00 PM</option>
<option value="6.00 - 8.00">6.00 - 8.00 PM</option>
</select>
<input type="text" name="age" placeholder="Enter your age" required>
<textarea name="comments" id="comments" cols="30" rows="10" placeholder="Enter your problem in detail"></textarea>
<br>
<i>Terms & Conditions applied</i>
<button>Submit</button>
</form>
</div>
</body>
</html>