-
Notifications
You must be signed in to change notification settings - Fork 263
/
aptmnt.html
179 lines (157 loc) · 5.26 KB
/
aptmnt.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>RapiDoc</title>
<script src="https://unpkg.com/scrollreveal"></script>
<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>