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aptmnt.html
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aptmnt.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>RapiDoc</title>
<style>
body {
font-family: Arial, sans-serif;
background-color: #0d3b4f; /* Dark teal background */
display: flex;
justify-content: center;
align-items: center;
height: 100vh;
margin: 0;
padding: 10px;
box-sizing: border-box;
}
.appointment-form {
background-color: #1b586f; /* Teal background */
max-width: 400px;
width: 100%;
margin: 20px;
padding: 20px;
border: 1px solid #ccc;
border-radius: 5px;
box-shadow: 0 2px 4px rgba(0, 0, 0, 0.1);
}
.form-group {
margin-bottom: 15px;
}
label {
display: block;
font-weight: bold;
margin-bottom: 5px;
color: #ffffff; /* White text for labels */
}
input[type="text"],
input[type="email"],
input[type="date"],
input[type="time"],
textarea,
select {
width: 100%;
padding: 10px;
border: 1px solid #1b586f; /* Teal border */
border-radius: 5px;
box-sizing: border-box;
background-color: #a6c8db; /* Light blue background */
color: #2c3e50; /* Dark text color */
transition: border-color 0.3s, box-shadow 0.3s;
}
input[type="text"]:focus,
input[type="email"]:focus,
input[type="date"]:focus,
input[type="time"]:focus,
textarea:focus,
select:focus {
border-color: #007bff;
outline: none;
box-shadow: 0 0 5px rgba(0, 123, 255, 0.5);
}
input[type="text"]:hover,
input[type="email"]:hover,
input[type="date"]:hover,
input[type="time"]:hover,
textarea:hover,
select:hover {
border-color: #007bff;
}
button {
width: 100%;
padding: 10px;
background-color: #34a0a4; /* Green button */
color: #ffffff; /* White text */
border: none;
border-radius: 5px;
cursor: pointer;
transition: background-color 0.3s, box-shadow 0.3s;
font-size: 16px;
}
button:hover {
background-color: #2b908b; /* Darker green on hover */
box-shadow: 0 2px 4px rgba(0, 0, 0, 0.2);
}
button:active {
background-color: #267a75;
}
@media (max-width: 600px) {
.appointment-form {
padding: 15px;
margin: 10px;
}
button {
padding: 12px;
}
input[type="text"],
input[type="email"],
input[type="date"],
input[type="time"],
textarea,
select {
padding: 8px;
}
}
</style>
</head>
<body>
<form action="submit_appointment.php" method="post" class="appointment-form">
<div class="form-group">
<label for="name">Your Name</label>
<input type="text" id="name" name="name" placeholder="Your Name" required>
</div>
<div class="form-group">
<label for="email">Your Email</label>
<input type="email" id="email" name="email" placeholder="Your Email" required>
</div>
<div class="form-group">
<label for="phone">Your Phone</label>
<input type="text" id="phone" name="phone" placeholder="Your Phone" required>
</div>
<div class="form-group">
<label for="date">Appointment Date</label>
<input type="date" id="date" name="date" placeholder="Appointment Date" required>
</div>
<div class="form-group">
<label for="age">Select Age</label>
<select id="age" name="age" required>
<option value="" disabled selected>Select Age</option>
<option value="Under 18">Under 18</option>
<option value="18-30">18-30</option>
<option value="31-50">31-50</option>
<option value="51-70">51-70</option>
<option value="71 and above">71 and above</option>
</select>
</div>
<div class="form-group">
<label for="location">Your Location</label>
<select id="location" name="location" required>
<option value="" disabled selected>Your Location</option>
<option value="Location 1">Hyderabad</option>
<option value="Location 2">Delhi</option>
<option value="Location 3">Chennai</option>
<option value="Location 4">Ahmedabad</option>
<option value="Location 5">Banglore</option>
<option value="Location 6">Kolkata</option>
</select>
</div>
<div class="form-group">
<label for="message">Message (Optional)</label>
<textarea id="message" name="message" placeholder="Message (Optional)"></textarea>
</div>
<button type="submit">Make an Appointment</button>
</form>
</body>
</html>