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appointment.html
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appointment.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>Doctor Appointment</title>
<link rel="stylesheet" href="Appointment.css">
</head>
<body>
<div class="container">
<h1>Book Your Doctor's Appointment</h1>
<form class="appointment-form" action=" https://swasthya.setmore.com/sely" method="POST" target="_blank">
<div class="form-group">
<label for="name">Full Name:</label>
<input type="text" id="name" name="name" placeholder="Enter your full name" required>
</div>
<div class="form-group">
<label for="email">Email:</label>
<input type="email" id="email" name="email" placeholder="Enter your email" required>
</div>
<div class="form-group">
<label for="phone">Phone Number:</label>
<input type="tel" id="phone" name="phone" placeholder="Enter your phone number" required>
</div>
<div class="form-group">
<label for="date">Appointment Date:</label>
<input type="date" id="date" name="date" required>
</div>
<div class="form-group">
<label for="doctor">Select Doctor:</label>
<select id="doctor" name="doctor" required>
<option value="" disabled selected>Select a doctor</option>
<option value="dr_smith">Dr. John Smith</option>
<option value="dr_jones">Dr. Emily Jones</option>
<option value="dr_brown">Dr. Michael Brown</option>
</select>
</div>
<div class="form-group">
<label for="message">Additional Notes:</label>
<textarea id="message" name="message" rows="4" placeholder="Any special concerns or requirements"></textarea>
</div>
<button type="submit" class="btn">Book Appointment</button>
</form>
</div>
</body>
</html>