-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathregistration.html
137 lines (121 loc) · 5.39 KB
/
registration.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8" />
<title>Registration Form</title>
<meta name="viewport" content="width=device-width,
initial-scale=1.0"/>
<link rel="stylesheet" href="registration.css"/>
<script defer src="./registrationscript.js"></script>
</head>
<body>
<div class="container">
<form id ="registrationForm" method="POST" name="google-sheet">
<h1 class="form-title">Registration Form</h1>
<form action="#">
<div class="main-user-info">
<div class="user-input-box">
<label for="fullName">Full Name:</label>
<input type="text" id="fullName" name="fullName" placeholder="Enter Full Name" required/>
</div>
<div class="user-input-box">
<label for="username">Username:</label>
<input type="text" id="username" name="username" placeholder="Enter Username" required/>
</div>
<div class="user-input-box">
<label for="email">Email:</label>
<input type="email" id="email" name="email" placeholder="Enter Email" required/>
</div>
<div class="user-input-box">
<label for="phone">Phone Number:</label>
<input type="tel" id="phone" name="phone" placeholder="Enter Phone Number" required/>
</div>
<div class="user-input-box">
<label for="password">Password:</label>
<input type="password" id="password" name="password" placeholder="Enter Password" required/>
</div>
<div class="user-input-box">
<label for="confirmPassword">Confirm Password:</label>
<input type="password" id="confirmPassword" name="confirmPassword" placeholder="Confirm Password" required/>
<span id="passwordMessage"></span>
</div>
<div class="user-input-box">
<label for="address">Address:</label>
<input type="text" id="address" name="address" placeholder="Enter Permanent address" required/>
</div>
<div class="user-input-box">
<label for="aadhar">Aadhar Number:</label>
<input type="text" id="aadhar" pattern="[0-9]{12}" placeholder="Enter Aadhar" name="Aadharnumber" required/>
</div>
</div>
<div class="gender-details-box">
<span class="gender-title">Gender</span>
<div class="gender-category">
<input type="radio" name="gender" id="male" value="Male">
<label for="male">Male</label>
<input type="radio" name="gender" id="female" value="Female">
<label for="female">Female</label>
<input type="radio" name="gender" id="other" value="Other">
<label for="other">Other</label>
</div>
</div>
<div class="Blood-group-box">
<span class="Blood-group-title">Blood-group</span>
<div class="blood-group-category">
<label for="group">Choose your blood group:</label>
<select name="blood-group" id="blood-group">
<option value="Not Selected" selected>Select</option>
<option value="O+ve">O+ve</option>
<option value="O-ve">O-ve</option>
<option value="A+ve">A+ve</option>
<option value="A-ve">A-ve</option>
<option value="B+ve">B+ve</option>
<option value="B-ve">B-ve</option>
<option value="AB+ve">AB+ve</option>
<option value="AB-ve">AB-ve</option>
</select>
</div>
</div>
<div class="Registering-as-box">
<span class="Registering-as-title">Registering as:</span>
<div class="Registering-category">
<label for="Registering">Designation:</label>
<select name="Registering-as" id="Registering" onchange="changeStatus()">
<option value="Not Selected" selected>Select</option>
<option value="Doctor">Doctor</option>
<option value="Staff">Staff</option>
<option value="Patient">Patient</option>
<option value="Admin">Admin</option>
</select>
</div>
</div>
<div class="Specialization" id="Specialization" class="hidden">
<div class="Specialization-category">
<label for="Specialization">Specialization :</label>
<select name="Specialization" id="Specialist">
<option value="Not Selected" selected>Select</option>
<option value="Cardiology">Cardiology</option>
<option value="Neurology">Neurology</option>
<option value="Orthopaedic">Orthopaedic</option>
<option value="Gynecology">Gynecology</option>
<option value="Dermatology">Dermatology</option>
<option value="Pediatrics">Pediatrics</option>
<option value="Pulmonology">Pulmonology</option>
<option value="Radiology">Radiology</option>
<option value="Dentistry">Dentistry</option>
<option value="ENT(Ear,Nose,Throat)">ENT(Ear,Nose,Throat)</option>
<option value="Urology">Urology</option>
</select>
</div>
</div>
<style>
.hidden {
display: none;
}
</style>
<div class="form-submit-btn">
<input type="submit" value="Register" name="submit">
</div>
</form>
</body>
</html>