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AppointmentForm.html
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AppointmentForm.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>Appointment Form</title>
<link rel="stylesheet" href="styles.css">
</head>
<body>
<div class="container content">
<h2>APPOINTMENT FORM</h2>
<form action="#" method="POST">
<label for="name">Patient's Name:</label>
<input type="text" id="name" name="name" required>
<label for="SEX">Patient's SEX:</label>
<SELECT type="text" id="name" name="name" required>
<option value="SEX">FEMALE </option>
<option value="SEX">MALE</option>
<option value="SEX">OTHERS</option>
</SELECT>
<label for="aGE">Patient's AGE:</label>
<input type="text" id="name" name="name" required>
<label for="phone">Phone Number:</label>
<input type="tel" id="phone" name="phone" pattern="[0-9]" required>
<label for="email">Email:</label>
<input type="email" id="email" name="email" required>
<label for="date">Preferred Date:</label>
<input type="date" id="date" name="date" required>
<label for="time">Preferred Time:</label>
<input type="time" id="time" name="time" required>
<label for="Department">Select Department:</label>
<select id="Department" name="Department" required>
<option value="" disabled selected>Select Department</option>
<option value="EMERH">EMERGENCY ONLY</option>
</select>
<label for="Department">Select Department:</label>
<select id="Department" name="Department" required>
<option value="" disabled selected>Select Department</option>
<option value="NEUROLOGY">NEUROLOGY</option>
<option value="PSYCHIATRY">PSYCHIATRY </option>
<option value="CARDIOLOGY">CARDIOLOGY</option>
<option value="ONCOLOGY">ONCOLOGY</option>
<option value="GYNAECOLOGY">GYNAECOLOGY</option>
<option value="DERMETAOLOGY">DERMETAOLOGY</option>
</select>
<label for="doctor">Select Doctor:</label>
<select id="doctor" name="doctor" required>
<option value="" disabled selected>Select Department</option>
<option value="NEUROLOGY">Dr.BRIJANSHI RASTOGI </option>
<option value="PSYCHIATRY">Dr.PALLAVI KATHAIT </option>
<option value="CARDIOLOGY">Dr.YOGESH JAIN</option>
<option value="ONCOLOGIST">Dr. MANYA GANDHI</option>
<option value="GYNAECOLOGY">Dr.PRIYANSHU DUBEY</option>
<option value="DERMETAOLOGY">Dr.KUSHAGRA BHARDWAJ</option>
</select>
</select>
<label for="DAY AVAILABLE">Select Day:</label>
<select id="DAY" name="DAY" required>
<option value="" disabled selected>CHECK AVAILABLE DAY</option>
<option value="NEUROLOGY">MONDAY </option>
<option value="PSYCHIATRY">TUESDAY </option>
<option value="CARDIOLOGY">WEDNESDAY</option>
<option value="ONCOLOGIST">THURSDAY</option>
<option value="GYNAECOLOGY">FRIDAY</option>
<option value="DERMETAOLOGY">SATURDAY</option>
<option value="ONLY EMERGENCY">SUNDAY</option>
</select>
<label for="reason">Reason for Appointment:</label>
<textarea id="reason" name="reason" rows="4" required></textarea>
<label for="notes">Additional Notes:</label>
<textarea id="notes" name="notes" rows="4"></textarea>
<button type="submit">Submit</button>
</form>
</div>
</body>
</html>