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patientreg.php
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<?php session_start();
if(isset($_SESSION['log_id'])){
header("location: dashboard.php");
}
?>
<html>
<head>
<title>Online Appointment System: Register</title>
<link href="https://fonts.googleapis.com/css?family=Roboto:300,400,500,700" rel="stylesheet">
<link href="css/style.css" type="text/css" rel="stylesheet" />
<link href="css/patientreg.css" type="text/css" rel="stylesheet" />
</head>
<body>
<style>
</style>
<div id="container">
<table id="wrap" cellspacing="0" border="0" cellpadding="0">
<tr>
<td colspan="2" id="header"><h1>Online Appointment System</h1></td>
</tr>
<tr>
<td colspan="2" id="menu">
<ul>
<li><a class="menu-item-active" href="index.php">Home</a></li>
<li><a href="about.php">About</a></li>
<?php if (isset($_SESSION['log_id'])) {
echo "<li><a href='dashboard.php'>Dashboard</a></li>";
} else {
echo "<li><a href='login.php'>Login</a></li>";
} ?>
</ul>
</td>
</tr>
<tr>
<td class="content">
<h1>Patient Registration</h1>
<div id="tab-form">
<form action="process.php" method="POST">
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Patient Name</label>
</div>
<div class="form-col">
<input type="text" name="name" data-validation="required custom" data-validation-regexp="^([a-zA-Z]+\s)([a-zA-Z])+$" data-sanitize="trim capitalize" data-validation-allowing=" " data-validation-error-msg="Enter first and last name only" placeholder="Enter your full name" autofocus>
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Username</label>
</div>
<div class="form-col">
<input type="text" name="username" data-validation="required alphanumeric server" data-validation-url="form_validate.php" data-validation-allowing="_" data-sanitize="trim lower" placeholder="Enter username">
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Address</label>
</div>
<div class="form-col">
<textarea data-validation="required" data-validation-error-msg="Please enter your address" name="address"></textarea>
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Mobile number</label>
</div>
<div class="form-col">
<input data-validation="required number length" data-validation-length="10" data-validation-error-msg="Please enter 10 digit mobile number" type="text" name="mobileno" maxlength="10">
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Guardian Name</label>
</div>
<div class="form-col">
<input type="text" data-validation="required" data-validation-error-msg="Please enter your guardian name" name="guardian">
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Emergency contact number</label>
</div>
<div class="form-col">
<input type="text" data-validation="required number length" data-validation-length="10" data-validation-error-msg="Please enter 10 digit mobile number" name="emcont" maxlength="10">
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Gender</label>
</div>
<div class="form-col">
<div class="form-radio-btn">
<input type="radio" name="gender" value="male">
male
</div>
<div class="form-radio-btn">
<input type="radio" name="gender" value="female">
female
</div>
<div class="form-radio-btn">
<input type="radio" data-validation="required" data-validation-error-msg="Please select an option" name="gender" value="other">
Others
</div>
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Blood group</label>
</div>
<div class="form-col">
<select name="bgroup" data-validation="required" data-validation-error-msg="Please select blood group">
<option value="" selected disabled>Select</option>
<option value="A+">A+</option>
<option value="A-">A-</option>
<option value="B+">B+</option>
<option value="B-">B-</option>
<option value="AB+">AB+</option>
<option value="AB-">AB-</option>
<option value="O+">O+</option>
<option value="O-">O-</option>
</select>
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Current medication</label>
</div>
<div class="form-col">
<input type="text" name="cur_medication">
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Email id</label>
</div>
<div class="form-col">
<input type="text" data-validation="email" name="email_id">
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Password</label>
</div>
<div class="form-col">
<input type="password" data-validation="strength" data-validation-strength="2" name="pass">
</div>
</div>
<div class="form-row">
<div class="form-col form-label w-50">
<label for="">Confirm password</label>
</div>
<div class="form-col">
<input type="password" data-validation="confirmation" data-validation-confirm="pass" data-validation-error-msg="Entered value do not match with your password." name="cnf_pass">
</div>
</div>
<div class="form-row">
<div class="form-col form-btn">
<button class="btn btn-submit" type="submit" name="patientreg">Submit</button>
<button class="btn btn-submit" type="reset">Reset</button>
</div>
</div>
</form>
</div>
</td>
<?php include('master/foot.php'); ?>