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phcy.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Medicine Order Form</title>
<style>
body {
font-family: 'Bahnschrift SemiBold', sans-serif;
margin: 0;
padding: 0;
display: flex;
justify-content: center;
align-items: center;
height: 100vh;
background-color: #f0f4f8;
}
.container {
display: flex;
background-color: #fff;
box-shadow: 0 4px 8px rgba(255, 255, 255, 0.1);
border-radius: 8px;
overflow: hidden;
max-width: 900px;
width: 100%;
}
.form-container {
padding: 40px;
flex: 1;
display: flex;
flex-direction: column;
}
.form-container h2 {
margin-bottom: 20px;
color: #2c3e50;
}
.form-group {
margin-bottom: 15px;
}
.form-group label {
display: block;
margin-bottom: 5px;
color: #34495e;
}
.form-group select {
width: 100%;
padding: 10px;
border: 1px solid #bdc3c7;
border-radius: 4px;
}
.form-group a {
display: inline-block;
background-color: #3498db;
color: #fff;
padding: 10px 20px;
border: none;
border-radius: 4px;
text-decoration: none;
text-align: center;
cursor: pointer;
}
.form-group a:hover {
background-color: #2980b9;
}
.image-container {
background: url('../static/159.jpg') no-repeat center center;
background-size: cover;
width: 47%; /* Adjust the width as per your design */
}
</style>
</head>
<body>
<div class="container">
<div class="form-container">
<h2>Order Medicine</h2>
<form>
<div class="form-group">
<label for="name">Name</label>
<select id="name" name="name">
<option value="john_doe">John Doe</option>
</select>
</div>
<div class="form-group">
<label for="email">Email</label>
<select id="email" name="email">
<option value="[email protected]">[email protected]</option>
</select>
</div>
<div class="form-group">
<label for="phone">Phone</label>
<select id="phone" name="phone">
<option value="123-456-7890">123-456-7890</option>
</select>
</div>
<div class="form-group">
<label for="address">Address</label>
<select id="address" name="address">
<option value="123_main_st">123 Main St</option>
</select>
</div>
<div class="form-group">
<label for="doctor">Doctor</label>
<select id="doctor" name="doctor">
<option value="dr_smith">Dr. Smith</option>
</select>
</div>
<div class="form-group">
<a href="{{ url_for('phcy2') }}">Next</a>
</div>
</form>
</div>
<div class="image-container"></div>
</div>
</body>
</html>