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recieveform.php
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>LifeSource Foundation</title>
<link rel="stylesheet" href="style.css">
</head>
<body>
<video autoplay loop muted plays-inline class="backvid">
<source src="img/1videoplayback.mp4" type="video/mp4">
</video>
<div class="navbar">
<nav>
<li>
<div class="verline"></div>
</li>
<a href="index.php"><img src="img/LifeSource Foundation-1 (2).png" alt="logo" height="50px"
width="200px"></a>
<ul>
<?php session_start();
$userLoggedIn = false;
if(isset($_SESSION['logged_in'])){
$userLoggedIn = true;
$uName = $_SESSION['username'];
}
?>
<li> <a href="index.php">HOME</a> </li>
<li> <a href="about.php">ABOUT US</a></li>
<li> <a href="donorpanel.php">INFORMATION</a> </li>
<li> <a href="donationform.php">DONATE BLOOD</a> </li>
<li> <a href="recieveform.php">RECIEVE BLOOD</a> </li>
<li>
<p class="undersquare">________</p>
</li>
<li id="signUp">
<a href="SignUp.php">SIGN UP
<?php
if($userLoggedIn){
echo "
<script language=javascript>
var signUp = document.getElementById('signUp');
signUp.style.visibility = 'hidden';
</script>
";
}else{
echo "
<script language=javascript>
var signUp = document.getElementById('signUp');
signUp.style.visibility = 'visible';
</script>
";
}
?>
</a>
</li>
<li id="login">
<a href="Login.php">LOGIN
<?php
if($userLoggedIn){
echo "
<script language=javascript>
var login = document.getElementById('login');
login.style.visibility = 'hidden';
</script>
";
}else{
echo "
<script language=javascript>
var login = document.getElementById('login');
login.style.visibility = 'visible';
</script>
";
}
?>
</a>
</li>
<li id="UserName" onclick="profileMenu()">
<a href="">
<?php
if($userLoggedIn){
echo "
<script language=javascript>
var uName = document.getElementById('UserName');
uName.innerHTML = " . json_encode($uName) . ";
uName.style.color = 'white';
function profileMenu(){
window.location.href='../welcome.php';
}
</script>
";
}else{
echo "
<script language=javascript>
var uName = document.getElementById('UserName');
signOut.style.visibility = 'hidden';
</script>
";
}
?>
</a>
</li>
<li id="SignOut" onclick="logOut()">Log Out
<?php
if($userLoggedIn){
echo "
<script language=javascript>
var signOut = document.getElementById('SignOut');
signOut.style.color = 'white';
function logOut(){
window.location.href = 'action/logout.php';
}
</script>
";
}else{
echo "
<script language=javascript>
var signOut = document.getElementById('SignOut');
signOut.innerHTML = 'SIGN OUT';
signOut.style.visibility = 'hidden';
</script>
";
}
?>
</li>
</ul>
</nav>
</div>
<div class="donateform">
<h1>Emergency Blood Requirement Form:</h1>
</div>
<div class="dform">
<form class="dformm" method="post" action="action/requestBlood.php">
<br>
<div id="dname">
<h2 class="dname">Name</h2>
<input class="dfirstname" type="text" name="first_name"> <br>
<label class="dfirstlabel">First Name</label>
<input class="dlastname" type="text" name="last_name"> <br>
<label class="dlastlabel">Last Name</label>
</div>
<div id="ddob">
<h2 class="ddob">Date Of Birth</h2>
<input class="dmonth" type="text" name="month">
<label class="dmonthlabel">Month</label>
<input class="dday" type="number" name="day">
<label class="ddaylabel">Day</label>
<input class="dyear" type="number" name="year">
<label class="dyearlabel">Year</label>
</div>
<h2 class="dname">Email Address</h2>
<input class="demail" type="email" name="email_address">
<h2 class="dname">Phone Number</h2>
<input class="dphone" type="number" name="phone_no">
<br>
<div id="dd">
<h2 class="dd">Hospital Location</h2>
<input class="hl" type="text" name="address"> <br>
<label class="daddresslabel_road">Address</label>
</div>
<br>
<h2 class="dnew">We Hope That You Are Doing Well And The Blood That You Will Recieve Will
Help You A Lot. We Wish You All The Best Now Please State Your Blood Type:
</h2><br>
<h2 class="dbloodtype">Blood Type</h2>
<select name="blood_type" class="doption" required>
<option disabled="disabled" selected="selected">Choose BloodType That You Need:</option>
<option value="A+">A+</option>
<option value="B+">B+</option>
<option value="O+">O+</option>
<option value="AB+">AB+</option>
<option value="A-">A-</option>
<option value="B-">B-</option>
<option value="O-">O-</option>
<option value="AB-">AB-</option>
</select>
<br>
<br>
<h2 id="ddonate">Are you:</h2>
<label class="dradio">
<input class="dradio-one" type="radio" name="gender" value="Male">
<span class="checkmark"></span>
Male
</label>
<label class="dradio">
<input class="dradio-two" type="radio" name="gender" value="Female">
<span class="checkmark"></span>
Female
</label>
<div id="ddisease">
<h2 class="ddisease">Please write down why you are in need of blood:</h2>
<input class="dddisease" type="text" name="disease"> <br>
</div>
<button class="dsubmit">Register To Recieve Blood</button>
<br><br>
</form>
</div>
</body>
</html>