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form.html
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form.html
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<!DOCTYPE html>
<html lang="en">
<head>
<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>HOSPITAL</title>
</head>
<style>
#name{
width: 100%;
padding: 12px 20px;
margin: 8px 0;
display: inline-block;
border: 1px solid #ccc;
border-radius: 4px;
box-sizing: border-box;
}
input[type=number], select {
width: 100%;
padding: 12px 20px;
margin: 8px 0;
display: inline-block;
border: 1px solid #ccc;
border-radius: 4px;
box-sizing: border-box;
}
input[type=email],select{
width: 100%;
padding: 12px 20px;
margin: 8px 0;
display: inline-block;
border: 1px solid #ccc;
border-radius: 4px;
box-sizing: border-box;
}
input[type=submit] {
width: 100%;
background-color: #4CAF50;
color: white;
padding: 14px 20px;
margin: 8px 0;
border: none;
border-radius: 4px;
cursor: pointer;
}
div {
border-radius: 5px;
background-color: #f2f2f2;
padding: 20px;
}
body{
font-size: large;
color: black;
}
h1{
font-weight: bold;
font-size: xx-large;
font-family: 'Segoe UI', Tahoma, Geneva, Verdana, sans-serif;
text-align: center;
}
</style>
<body>
<h1>HOSPITALS</h1>
<div>
<form action="hos.php" method="POST">
<label for="name">Name</label>
<select name="Name" id="Name">
<option value="select name..">select name..</option>
<option value="KAMLA NEHRU MEMORIAL HOSPITAL">KAMLA NEHRU MEMORIAL HOSPITAL</option>
<option value="SWAROOP RANI NEHRU HOSPITAL">SWAROOP RANI NEHRU HOSPITAL</option>
<option value="DUFFERIN HOSPITAL">DUFFERIN HOSPITAL</option>
<option value="MOTILAL NEHRU HOSPITAL">MOTILAL NEHRU HOSPITAL</option>
<option value="NAZRETH HOSPITAL">NAZRETH HOSPITAL</option>
<option value="TEJ BAHADUR SAPRU HOSPITAL">TEJ BAHADUR SAPRU HOSPITAL</option>
<option value="CENTRAL HOSPITAL">CENTRAL HOSPITAL</option>
<option value="ALKA HOSPITAL">ALKA HOSPITAL</option>
<option value="BHOLA HOSPITAL">BHOLA HOSPITAL</option>
<option value="CITY HOSPITAL">CITY HOSPITAL</option>
</select>
<br>
<label for="need">Oxygen cyclinder reqirement(in next 1 hour)</label>
<input type="number" name="Need" id="Need" placeholder="Your need...">
<br>
<label for="email">Email</label>
<input type="email" name="Email" id="Email" placeholder="Official email...">
<br>
<input type="submit" name="submit" value="Submit Now">
</form>
</div>
</body>
</html>