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admit.html
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<!doctype html>
<html lang="en">
<head>
<!-- Required meta tags -->
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<!-- Bootstrap CSS -->
<link href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css" rel="stylesheet">
<!-- google fonts -->
<link href="https://fonts.googleapis.com/css2?family=Poppins:wght@400;500;600;700;800;900&display=swap" rel="stylesheet">
<!-- fontawesome -->
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.1.1/css/all.min.css">
<!-- style css -->
<link rel="stylesheet" href="css/style.css">
<title>Hello, world!</title>
</head>
<body>
<!-- topbar -->
<section class="topBar">
<div class="container">
<nav class="navbar navbar-expand-lg navbar-light bg-transparent">
<div class="container-fluid">
<a class="navbar-brand" href="index.html">
<img src="img/logo.png" class="img-fluid logo" alt="">
</a>
<button class="navbar-toggler" type="button" data-bs-toggle="collapse" data-bs-target="#navbarSupportedContent" aria-controls="navbarSupportedContent" aria-expanded="false" aria-label="Toggle navigation">
<span class="navbar-toggler-icon"></span>
</button>
<div class="collapse navbar-collapse" id="navbarSupportedContent">
<ul class="navbar-nav ms-auto mb-2 mb-lg-0">
<li class="nav-item">
<a class="nav-link text-dark" href="dr-list.php">
Doctor List
</a>
</li>
<li class="nav-item">
<a class="nav-link text-dark" href="patient-list.php">
Patient List
</a>
</li>
<li class="nav-item dropdown">
<a class="nav-link dropdown-toggle text-dark" href="#" id="navbarDropdown" role="button" data-bs-toggle="dropdown" aria-expanded="false">
Booking
</a>
<ul class="dropdown-menu" aria-labelledby="navbarDropdown">
<li><a class="dropdown-item" href="checkup.htmls">Regular Checkup</a></li>
<li><a class="dropdown-item" href="admit.html">Admit</a></li>
</ul>
</li>
<li class="nav-item">
<a class="nav-link text-dark" href="contact.html">
Contact Us
</a>
</li>
<li class="nav-item">
<a class="nav-link text-dark" href="login-signup.html">
Login/Signup
</a>
</li>
<li class="nav-item">
<a class="nav-link text-dark" href="search.html">
<i class="fa fa-search"></i>
</a>
</li>
</ul>
</div>
</div>
</nav>
</div>
</section>
<!-- topbar -->
<!-- checkup -->
<section class="checkup py-4">
<div class="container">
<div class="text-center">
<h2 class="fw-bold">
Request for Admit
</h2>
</div>
<form action="php/admit.php" method="post" class="mt-4">
<div class="row">
<div class="col-md-6 p-3">
<div class="form-item">
<label for="" class="fw-bold">
Patient Name
</label>
<input type="text" class="form-control my-2 py-2" placeholder="Patient Name" name="name" id="">
</div>
</div>
<div class="col-md-6 p-3">
<div class="form-item">
<label for="" class="fw-bold">
Patient Age
</label>
<input type="text" class="form-control my-2 py-2" placeholder="Patient Age" name="age" id="">
</div>
</div>
<div class="col-md-6 p-3">
<div class="form-item">
<label for="" class="fw-bold">
Patient Gender
</label>
<select name="gender" id="" class="form-control my-2 py-2">
<option value="male">Male</option>
<option value="female">Female</option>
<option value="other">Other</option>
</select>
</div>
</div>
<div class="col-md-6 p-3">
<div class="form-item">
<label for="" class="fw-bold">
Contact Number
</label>
<input type="text" class="form-control my-2 py-2" placeholder="Contact" name="contact" id="">
</div>
</div>
<div class="col-md-6 p-3">
<div class="form-item">
<label for="" class="fw-bold">
Additional Contact
</label>
<input type="text" class="form-control my-2 py-2" placeholder="Additional Contact" name="a_contact" id="">
</div>
</div>
<div class="col-md-6 p-3">
<div class="form-item">
<label for="" class="fw-bold">
Address
</label>
<input type="text" class="form-control my-2 py-2" placeholder="Address" name="address" id="">
</div>
</div>
<div class="col-12 p-3">
<div class="text-center">
<h4 class="fw-bold text-center">
Describe The Problem
</h4>
</div>
</div>
<div class="col-12 p-3">
<textarea name="problem" class="form-control" placeholder="Star Writting here" id="" cols="30" rows="10"></textarea>
</div>
<div class="col-12 py-4 px-3">
<div class="text-end">
<button class="btn btn-success" name="AddAdmit">
Admit
</button>
</div>
</div>
</div>
</form>
</div>
</section>
<!-- checkup -->
<!-- footer -->
<section class="footer py-4">
<div class="container">
<div class="card border-0 bg-dark">
<div class="card-body p-4">
<div class="text-center">
<a href="" class="">
<img src="img/logo.png" class="img-fluid logo" alt="">
</a>
</div>
<div class="row mt-4">
<div class="col-md-3 p-3">
<p class="fs-20 text-white fw-bold">
Explore Services
</p>
<ul class="list-unstyled m-0 p-0">
<li>
<a href="" class="text-white">
Checkup
</a>
</li>
<li>
<a href="" class="text-white">
Admit
</a>
</li>
</ul>
</div>
<div class="col-md-3 p-3">
<p class="fs-20 text-white fw-bold">
Useful Links
</p>
<ul class="list-unstyled m-0 p-0">
<li>
<a href="" class="text-white">
Contact Us
</a>
</li>
<li>
<a href="" class="text-white">
<i class="fab fa-facebook"></i> Facebook
</a>
</li>
<li>
<a href="" class="text-white">
<i class="fab fa-twitter"></i> Twitter
</a>
</li>
<li>
<a href="" class="text-white">
<i class="fab fa-youtube"></i> Youtube
</a>
</li>
</ul>
</div>
<div class="col-md-3 p-3">
<p class="fs-20 text-white fw-bold">
Listings
</p>
<ul class="list-unstyled m-0 p-0">
<li>
<a href="" class="text-white">
Doctor List
</a>
</li>
<li>
<a href="" class="text-white">
Patient List
</a>
</li>
</ul>
</div>
<div class="col-md-3 p-3">
<p class="fs-20 text-white fw-bold">
Location
</p>
<ul class="list-unstyled m-0 p-0">
<li class="text-white">
Patuakhali Science & Technology University
</li>
<li class="text-white">
Dumki, Patuakhali
</li>
</ul>
</div>
</div>
</div>
</div>
</div>
</section>
<!-- footer -->
<!-- jQuery -->
<script src="https://code.jquery.com/jquery-3.6.0.min.js"></script>
<!-- Bootstrap Bundle with Popper -->
<script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.bundle.min.js"></script>
<!-- main js -->
<script src="js/main.js"></script>
</body>
</html>