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HospitalRegister.php
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HospitalRegister.php
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<!DOCTYPE html>
<html lang="en">
<head>
<title>Hospital SignUp</title>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js"></script>
<style>
.navbar-custom {
background-color: #ff3333;
border-color: #ff1212;
background-image: -webkit-gradient(linear, left 0%, left 100%, from(#ff6666), to(#ff3333));
background-image: -webkit-linear-gradient(top, #ff6666, 0%, #ff3333, 100%);
background-image: -moz-linear-gradient(top, #ff6666 0%, #ff3333 100%);
background-image: linear-gradient(to bottom, #ff6666 0%, #ff3333 100%);
background-repeat: repeat-x;
filter: progid:DXImageTransform.Microsoft.gradient(startColorstr='#ffff6666', endColorstr='#ffff3333', GradientType=0);
padding: 10px 0px;
}
.navbar-custom .navbar-brand {
color: #ffffff;
}
.navbar-custom .navbar-brand:hover,
.navbar-custom .navbar-brand:focus {
color: #e6e6e6;
background-color: transparent;
}
.navbar-custom .navbar-text {
color: #ffffff;
}
.navbar-custom .navbar-nav > li:last-child > a {
border-right: 1px solid #ff1212;
}
.navbar-custom .navbar-nav > li > a {
color: #ffffff;
border-left: 1px solid #ff1212;
}
.navbar-custom .navbar-nav > li > a:hover,
.navbar-custom .navbar-nav > li > a:focus {
color: #c0c0c0;
background-color: transparent;
}
.navbar-custom .navbar-nav > .active > a,
.navbar-custom .navbar-nav > .active > a:hover,
.navbar-custom .navbar-nav > .active > a:focus {
color: #c0c0c0;
background-color: #ff1212;
background-image: -webkit-gradient(linear, left 0%, left 100%, from(#ff1212), to(#ff4545));
background-image: -webkit-linear-gradient(top, #ff1212, 0%, #ff4545, 100%);
background-image: -moz-linear-gradient(top, #ff1212 0%, #ff4545 100%);
background-image: linear-gradient(to bottom, #ff1212 0%, #ff4545 100%);
background-repeat: repeat-x;
filter: progid:DXImageTransform.Microsoft.gradient(startColorstr='#ffff1212', endColorstr='#ffff4545', GradientType=0);
}
.navbar-custom .navbar-nav > .disabled > a,
.navbar-custom .navbar-nav > .disabled > a:hover,
.navbar-custom .navbar-nav > .disabled > a:focus {
color: #cccccc;
background-color: transparent;
}
.navbar-custom .navbar-toggle {
border-color: #dddddd;
}
.navbar-custom .navbar-toggle:hover,
.navbar-custom .navbar-toggle:focus {
background-color: #dddddd;
}
.navbar-custom .navbar-toggle .icon-bar {
background-color: #cccccc;
}
.navbar-custom .navbar-collapse,
.navbar-custom .navbar-form {
border-color: #ff0f0f;
}
.navbar-custom .navbar-nav > .dropdown > a:hover .caret,
.navbar-custom .navbar-nav > .dropdown > a:focus .caret {
border-top-color: #c0c0c0;
border-bottom-color: #c0c0c0;
}
.navbar-custom .navbar-nav > .open > a,
.navbar-custom .navbar-nav > .open > a:hover,
.navbar-custom .navbar-nav > .open > a:focus {
background-color: #ff1212;
color: #c0c0c0;
}
.navbar-custom .navbar-nav > .open > a .caret,
.navbar-custom .navbar-nav > .open > a:hover .caret,
.navbar-custom .navbar-nav > .open > a:focus .caret {
border-top-color: #c0c0c0;
border-bottom-color: #c0c0c0;
}
.navbar-custom .navbar-nav > .dropdown > a .caret {
border-top-color: #ffffff;
border-bottom-color: #ffffff;
}
@media (max-width: 767) {
.navbar-custom .navbar-nav .open .dropdown-menu > li > a {
color: #ffffff;
}
.navbar-custom .navbar-nav .open .dropdown-menu > li > a:hover,
.navbar-custom .navbar-nav .open .dropdown-menu > li > a:focus {
color: #c0c0c0;
background-color: transparent;
}
.navbar-custom .navbar-nav .open .dropdown-menu > .active > a,
.navbar-custom .navbar-nav .open .dropdown-menu > .active > a:hover,
.navbar-custom .navbar-nav .open .dropdown-menu > .active > a:focus {
color: #c0c0c0;
background-color: #ff1212;
}
.navbar-custom .navbar-nav .open .dropdown-menu > .disabled > a,
.navbar-custom .navbar-nav .open .dropdown-menu > .disabled > a:hover,
.navbar-custom .navbar-nav .open .dropdown-menu > .disabled > a:focus {
color: #cccccc;
background-color: transparent;
}
}
.navbar-custom .navbar-link {
color: #ffffff;
}
.navbar-custom .navbar-link:hover {
color: #c0c0c0;
}
.field{
border-radius: 5px;
border: 1px solid #ccc;
-webkit-border-radius: 5px;
}
.foot{
background-color: #d9d9d9;
}
</style>
<script>
function checkPassword(){
var pwd = document.getElementById("Hpwd").value;
var confirmpwd = document.getElementById("Hconfirmpwd").value;
if(pwd != confirmpwd){
document.getElementById("Hconfirmpwd").style.borderColor = "red";
}
else
document.getElementById("Hconfirmpwd").style.borderColor = "";
}
function checkPassword1(){
var pwd = document.getElementById("Hpwd");
var confirmpwd = document.getElementById("Hconfirmpwd");
if(pwd.value != confirmpwd.value){
document.getElementById('errfn').innerHTML="Password do not match";
confirmpwd.value = "";
}
else{
document.getElementById('errfn').innerHTML="";
}
}
</script>
</head>
<body>
<nav class="navbar navbar-custom navbar-fixed-top">
<div class="container">
<div class="navbar-header">
<button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#navCollapse">
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
<!--<img src="logo1.JPG" style="padding: 0;" class="img-rounded img-responsive navbar">-->
<a class="navbar-brand" href="Page.php"><span style="color: #FFFFFF;">Red Drop</span></a>
</div>
</div>
</nav>
<div class="container" style="margin-top:100px;;">
<h2>Register as a Hospital</h2>
</div>
<div class="container">
<ul class="breadcrumb">
<li><a href="Page.php">Home</a></li>
<li class="active">Register as Hospital</li>
</ul>
</div>
<br>
<!-- Login Information -->
<form class="form-horizontal autofocus" action="Hospital_Register_Php.php" method="POST">
<div class="container">
<legend>Login Information</legend>
<br><br>
<div class="form-group">
<label class="control-label col-sm-2" for="HUsername">Username:</label>
<div class="col-sm-10">
<input type="text" class="form-control" id="HUsername" placeholder="Enter username" required maxlength="20" name="HUsername">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="HName">Hospital Name:</label>
<div class="col-sm-10">
<input type="text" class="form-control" id="HName" required placeholder="Enter your Hospital name" maxlength="50" name="HName">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="HAddress">Hospital Address:</label>
<div class="col-sm-10">
<input type="text" class="form-control" id="HAddress" required placeholder="Enter your Hospital Address" maxlength="50" name="HAddress">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="HMobile">Hospital Mobile:</label>
<div class="col-sm-10">
<input type="text" class="form-control" id="HMobile" required placeholder="Enter your Hospital Mobile" maxlength="50" name="HMobile">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="HEmail">Email:</label>
<div class="col-sm-10">
<input type="email" class="form-control" required id="HEmail" placeholder="Enter email" maxlength="30" name="HEmail">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="Hpwd">Password:</label>
<div class="col-sm-10">
<input type="password" class="form-control" required id="Hpwd" placeholder="Enter password" maxlength="30" name="Hpwd">
<div id="errfn"></div>
</div>
</div>
<div id="checkpwd"></div>
<div class="form-group">
<label class="control-label col-sm-2" for="Hconfirmpwd">Confirm Password:</label>
<div class="col-sm-10">
<input type="password" class="form-control" required id="Hconfirmpwd" placeholder="Confirm password" maxlength="30" name="Hcpwd" onkeyup="checkPassword()" onchange="checkPassword1()">
</div>
</div>
</div>
<br><br><br>
<!-- Receptionist Information -->
<div class="container">
<legend>Receptionist Information</legend>
<br><br>
<div class="form-group">
<label class="control-label col-sm-2" for="RecepFullName">Full Name:</label>
<div class="col-sm-10">
<input type="text" class="form-control" required id="RecepFullName" maxlength="30" placeholder="Enter your name" name="RecepFullName">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="RecepEmail">Email:</label>
<div class="col-sm-10">
<input type="email" class="form-control" required id="RecepEmail" maxlength="30" placeholder="Enter email" name="RecepEmail">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="RecepAge">Age:</label>
<div class="col-sm-10">
<input type="number" class="form-control" required id="RecepAge" placeholder="Enter age" name="RecepAge">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="RecepGender">Gender:</label>
<div class="col-sm-10">
<select class="form-control " id="RecepGender" name="RecepGender">
<option value="Male" required>Male</option>
<option value="Female" required>Female</option>
<option value="Gender" selected="selected" required>Select</option>
</select>
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="RecepMobile">Mobile Number:</label>
<div class="col-sm-10">
<input type="tel" class="form-control" required id="RecepMobile" maxlength="10" placeholder="Enter your mobile number" name="RecepMobile">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="RecepAddress">Address:</label>
<div class="col-sm-10">
<input type="textarea" class="form-control" required id="RecepAddress" maxlength="50" placeholder="Enter your address" name="RecepAddress">
</div>
</div>
<div class="form-group">
<div class="city-wrap">
<label class="control-label col-sm-2" for="RecepCity">City(lowercase):</label>
<div class="col-sm-10">
<input type="text" class="form-control" required name="RecepCity" id="RecepCity" maxlength="50" placeholder="Enter your city">
</div>
</div>
</div>
</div>
<br><br><br>
<!-- Manager Information -->
<div class="container">
<legend>Manager Information</legend>
<br><br>
<div class="form-group">
<label class="control-label col-sm-2" for="MagFullName">Full Name:</label>
<div class="col-sm-10">
<input type="text" class="form-control" required id="MagFullName" maxlength="30" placeholder="Enter your name" name="MagFullName">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="MagEmail">Email:</label>
<div class="col-sm-10">
<input type="email" class="form-control" required id="MagEmail" maxlength="30" placeholder="Enter email" name="MagEmail">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="MagAge">Age:</label>
<div class="col-sm-10">
<input type="number" class="form-control" required id="MagAge" placeholder="Enter age" name="MagAge">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="Gender">Gender:</label>
<div class="col-sm-10">
<select class="form-control " id="MagGender" name="MagGender">
<option value="Male" required>Male</option>
<option value="Female" required>Female</option>
<option value="Gender" required selected="selected">Select</option>
</select>
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="MagMobile">Mobile Number:</label>
<div class="col-sm-10">
<input type="tel" class="form-control" required id="MagMobile" maxlength="10" placeholder="Enter your mobile number" name="MagMobile">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="MagAddress">Address:</label>
<div class="col-sm-10">
<input type="textarea" class="form-control" required id="MagAddress" maxlength="50" placeholder="Enter your address" name="MagAddress">
</div>
</div>
<div class="form-group">
<div class="city-wrap">
<label class="control-label col-sm-2" for="MagCity">City(lowercase):</label>
<div class="col-sm-10">
<input type="text" class="form-control" required name="MagCity" maxlength="50" id="MagCity" placeholder="Enter your city">
</div>
</div>
</div>
</div>
<br><br><br>
<center>
<input type="submit" name="HRegister" data-toggle="modal" data-target="#HospitalRegister" class="btn-primary btn-lg" value="Register" required>
</center>
</form>
<br><br><br>
<!--<div class="container field" style="background-color: #4d4d4d; height:100px">
<center>
<h5>Copyright © BloodBank Database System 2017</h5>
</center>
</div>-->
<br><br><br>
<!-- FOOTER -->
<div class="divider"></div>
<div class="foot">
<footer class="page-footer center-on-small-only">
<!--Footer Links-->
<div class="container-fluid">
<div class="row">
<!--First column-->
<div class="col-md-3"></div>
<div class="col-md-4">
<h3 class="title">Red Drop</h3>
<p>A life may depend on a gesture from you, a bottle of Blood.</p>
</div><br>
<div class="col-md">
</div>
</div>
</div>
<br>
<div class="footer-copyright">
<div class="container-fluid text-center">
© 2016 Copyright: <a href="Page.php"> RedDrop </a>
</div>
</div>
<br><br>
</footer>
</div>
</body>
</html>