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treatment appointment.html
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treatment appointment.html
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<!DOCTYPE html>
<html>
<head>
<title>Treatment Appointment Form</title>
<img src="24-7.jpg" style="width:500px;height:200px;">
<style>
body {
font-family: Arial, sans-serif;
margin: 0;
padding: 0;
}
h1 {
text-align: center;
margin-top: 30px;
}
form {
max-width: 600px;
margin: 0 auto;
padding: 20px;
border: 1px solid #25383C;
border-radius: 20px;
box-shadow: 0 0 20px rgba(0, 0, 0, 0.1);
}
label {
display: block;
margin-top: 20px;
font-weight: bold;
}
input[type="text"],
input[type="email"],
input[type="tel"],
select,
textarea {
width: 100%;
padding: 10px;
border: 1px solid #ddd;
border-radius: 5px;
box-sizing: border-box;
font-size: 16px;
margin-bottom: 20px;
}
select option:first-child {
display: none;
}
display: -ms-flexbox;
display: -webkit-box;
display: flex;
max-width: 675px;
min-height: 400px;
margin-bottom: 125px;
background-color: #ffffff;
border-radius: 5px;
box-shadow: 3px 3px 20px rgba(0, 0, 0, 0.1);
}
input[type="submit"]:hover {
background-color: #3e8e41;
}
</style>
</head>
<body>
<h1>Treatment Appointment</h1>
<form action="submit-appointment.php" method="post">
<label for="number">Treatment Id:</label>
<input type="number" id="name" name="number" required>
<label for="number">Patient Id:</label>
<input type="number" id="number" name="number" required>
<label for="text">Current Condition:</label>
<input type="tel" id="text" name="text" required>
<label for="treatment">Treatment:</label>
<select id="treatment" name="treatment" required>
<option value="">Select treatment</option>
<option value="Teeth Cleaning">Teeth Cleaning</option>
<option value="Root Canal">Root Canal</option>
<option value="Chemotherapy">Chemotherapy</option>
<option value="Orthopedics">Orthopedics</option>
<option value="Neurology">Neurology</option>
<option value="Dylasis">Dylasis</option>
<option value="Laproscopy">Laproscopy</option>
<option value="Radiation Therapy">Radiation Therapy</option>
<option value="Blood transfusion">Blood transfusion</option>
<option value="Hormonal Therapy">Hormonal Therapy</option>
<option value="Others">Others</option>
</select>
<label for="date">Date:</label>
<input type="date" id="date" name="date" required>
<label for="time">Time:</label>
<input type="time" id="time" name="time" required>
<label for="notes">Notes:</label>
<textarea id="notes" name="notes" rows="5"></textarea>
<a href="payment.html" style="
display: inline-block;
padding: 10px;
background-color: green;
color: white;
text-decoration: none;
border-radius: 5px;">Payment</a>
</form>
<style>
body {
background-image: url('appointment1.jpg');
background-repeat: no-repeat;
background-attachment: fixed;
background-size: 100% 100%;
}
</style>
</body>
</html>