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patient-signup.html
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patient-signup.html
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<!DOCTYPE html>
<html lang="en" dir="ltr">
<head>
<h1 class="head">Register</h1>
<meta charset="utf-8">
<style>
body{ background: #000000;
background: -webkit-linear-gradient(to right,#F5F7FA,#B8C6DB);
background: linear-gradient(to right, #F5F7FA,#B8C6DB);
font-family: calibri;
}
.head{
font-family: cursive;
font-style: oblique;
text-align: left;
color: black;
text-shadow: 2px 1px #403a3a;
}
.textbox {
color:white;
height: 25px;
width: 100px;
border-radius: 25px;
border-bottom-color: rgb(39, 41, 37);
background-color: rgba(0, 0, 0, 0.5);
}
.textbox1{
color: white;
height: 25px;
width: 200px;
border-radius: 25px;
border-bottom-color: rgb(39, 41, 37);
background-color: rgba(0, 0, 0, 0.5);
}
.textbox:focus {
border: 0.5px solid black;
outline: none;
}
.topleftbox1{
display: inline-block;
position: absolute;
top:5%;
left: 80%;
padding: 10px 20px 10px 20px;
border-radius: 25px;
background-color: rgba(0,0,0,0.50);
font-size: 20px;
font-family: serif;
border:1px solid black;
font-weight: bold;
text-align: center;
}
#image1{
height:60px;
width:70px;
position: absolute;
top:-3%;
left:40%;
}
.toprightbox1{
display: inline-block;
position: absolute;
border-radius: 25px;
top:5%;
left: 90%;
padding: 10px 20px 10px 20px;
background-color: rgba(0,0,0,0.50);
font-size: 20px;
font-family: serif;
border:1px solid black;
font-weight: bold;
text-align: center;
}
a{
text-decoration: none;
color:white;
}
a:hover{
color: red;
text-decoration: underline;
}
.button{
color: white;
border-radius: 25px;
background-color:black;
width: 100px;
height: 30px;
position: relative;
left: 38%;
}
.box{
position: absolute;
top: 50%;
left: 50%;
transform: translate(-50%,-50%);
width: 380px;
padding: 20px;
background: linear-gradient(to right,#03C8A8,#89D8D3);
border: 1px solid black;
border-radius: 25px;
}
.insidebox{
text-align: center;
color: black;
}
</style>
<title>Pharmaceutical Management System</title>
</head>
<body>
<h1 class='heading'> <b></b></h1>
<br> <br> <br> <br>
<div class="box">
<div class="insidebox">
<form action="patients-signup.php" method="POST">
<img id="image1"
src="images\service1.png">
<h2> <b> SIGN UP </b></h2>
Full name:<br>
<input type="text" class="textbox" name="fname" placeholder="first name">
<input type="text" class="textbox" name="lname" placeholder="last name">
<br><br>
Email:<br>
<input type="email" class="textbox1" name="Email" placeholder="Enter your email">
<br><br>
Age:
<input type="number" class="textbox" name="age" placeholder="current age">
<br> <br>
Phone number: <br>
<select class="textbox">
<option> +91 </option>
</select>
<input type="phone" class="textbox" name="MobileNo" maxlength="10">
<br> <br>
Gender:
<input type="radio" name="gender" value="Male">Male
<input type="radio" name="gender" value="Female">Female
<br> <br>
Hospital name:
<input type="text" class="textbox" name="hospitalname" placeholder="H name"> <br> <br>
Password:
<input type="password" class="textbox" name="password" placeholder="Password"> <br> <br>
<button class="button" type="submit" name="patients-signup">Register</button>
</form>
</div>
</div>
<div class="toprightbox1">
<a href="index.php">HOME</a>
</div>
<div class="topleftbox1">
<a href="login-patient.html">LOG-IN</a>
</div>
</html>