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doctor_reg.html
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doctor_reg.html
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<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<title>Healthcare</title>
<link rel="stylesheet" type="text/css" href="./css/bootstrap.min.css">
<link rel="stylesheet" type="text/css" href="./css/styles.css">
</head>
<body>
<div class="vertical-center">
<div class="container">
<div class="row">
<div class="col-md-8 col-md-offset-2 well">
<h1 class="text-center">Doctor Registration</h1>
<form action="doctor_reg.php" method = "POST">
<div class="form-group">
<label>Name</label>
<div class="input-group">
<span class="input-group-addon">
<i class="glyphicon glyphicon-user"> </i>
</span>
<input type="text" name="name" class="form-control" required>
</div>
</div>
<div class="form-group">
<label>Email</label>
<div class="input-group">
<span class="input-group-addon">
<i class="glyphicon glyphicon-envelope"> </i>
</span>
<input type="email" name="email" class="form-control" required>
</div>
</div>
<div class="form-group">
<label>Phone</label>
<div class="input-group">
<span class="input-group-addon">
<i class="glyphicon glyphicon-earphone"> </i>
</span>
<input type="text" name="phone" class="form-control" required>
</div>
</div>
<div class="form-group">
<label>Date of birth</label>
<div class="input-group">
<span class="input-group-addon">
<i class="glyphicon glyphicon-stats"> </i>
</span>
<input type="date" name="dob" class="form-control" required>
</div>
</div>
<div class="form-group">
<label>Address</label>
<div class="input-group">
<span class="input-group-addon">
<i class="glyphicon glyphicon-home"> </i>
</span>
<input type="text" name="address" class="form-control" required>
</div>
</div>
<div class="form-group">
<label>Qualifications</label>
<div class="input-group">
<span class="input-group-addon">
<i class="glyphicon glyphicon-education"> </i>
</span>
<input type="text" name="qualifications" class="form-control" required>
</div>
</div>
<div class="form-group">
<label>Password</label>
<div class="input-group">
<span class="input-group-addon">
<i class="glyphicon glyphicon-asterisk"></i>
</span>
<input type="password" name="password" class="form-control" required>
</div>
</div>
<div class="form-group">
<label> Retype password</label>
<div class="input-group">
<span class="input-group-addon">
<i class="glyphicon glyphicon-asterisk"></i>
</span>
<input type="password" name="repassword" class="form-control" required>
</div>
</div>
<div class="form-group">
<input type="submit" value="REGISTER" class="btn btn-primary btn-block">
</div>
</form>
</div>
</div>
</div>
</div>
</body>
</html>