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IPregistration form.html
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IPregistration form.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">
<meta name="description" content="">
<meta name="author" content="">
<title>Health Tracker</title>
<!-- css -->
<link href="css/bootstrap.min.css" rel="stylesheet" type="text/css">
<link href="font-awesome/css/font-awesome.min.css" rel="stylesheet" type="text/css" />
<link rel="stylesheet" type="text/css" href="plugins/cubeportfolio/css/cubeportfolio.min.css">
<link href="css/nivo-lightbox.css" rel="stylesheet" />
<link href="css/nivo-lightbox-theme/default/default.css" rel="stylesheet" type="text/css" />
<link href="css/owl.carousel.css" rel="stylesheet" media="screen" />
<link href="css/owl.theme.css" rel="stylesheet" media="screen" />
<link href="css/animate.css" rel="stylesheet" />
<link href="css/style.css" rel="stylesheet">
<!-- boxed bg -->
<link id="bodybg" href="bodybg/bg1.css" rel="stylesheet" type="text/css" />
<!-- template skin -->
<link id="t-colors" href="color/default.css" rel="stylesheet">
</head>
<body id="page-top" data-spy="scroll" data-target=".navbar-custom">
<div id="wrapper">
<nav class="navbar navbar-custom navbar-fixed-top" role="navigation">
<div class="top-area">
<div class="container">
<div class="row">
<div class="col-sm-6 col-md-6">
<p class="bold text-left">Monday - Sunday, 24 hour service</p>
</div>
<div class="col-sm-6 col-md-6">
<p class="bold text-right">Call us now +62 007 43 221</p>
</div>
</div>
</div>
</div>
<div class="container navigation">
<!-- Collect the nav links, forms, and other content for toggling -->
<div class="collapse navbar-collapse navbar-right navbar-main-collapse">
<ul class="nav navbar-nav">
<li><a href="iphome.html">Home</a></li>
<li><a href="chart.php">View Graph</a></li>
<li><a href="index.html">Logout</a></li>
</ul>
</div>
<!-- /.navbar-collapse -->
</div>
<!-- /.container -->
</nav>
<!-- Section: intro -->
<section id="intro" class="intro">
<div class="intro-content">
<div class="container">
<div class="row">
<div class="col-lg-9">
<div class="wow fadeInDown" data-wow-offset="0" data-wow-delay="0.1s">
</div>
<div class="wow fadeInUp" data-wow-offset="0" data-wow-delay="0.1s">
<div class="col-lg-9">
<div class="form-wrapper">
<div class="wow fadeInRight" data-wow-duration="2s" data-wow-delay="0.2s">
<div class="panel panel-skin">
<div class="panel-heading">
<h3 class="panel-title"><span class="fa fa-pencil-square-o"></span> Registration Form</small></h3>
</div>
<div class="panel-body">
<form role="form" class="lead"method="POST" action="IPregistration.php" >
<div class="row">
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>First Name</label>
<input type="text" name="fname" id="fname" class="form-control input-md">
</div>
</div>
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>Last Name</label>
<input type="text" name="lname" id="lname" class="form-control input-md">
</div>
</div>
</div>
<div class="row">
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>Age</label>
<input type="text" name="age" id="age" class="form-control input-md">
</div>
</div>
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>Sex</label>
<select name="sex" id="sex">
<option value="Select option" class="form-control input-md">Select Option</option>
<option value="male" class="form-control input-md">Male</option>
<option value="female" class="form-control input-md">Female</option>
<option value="transgender" class="form-control input-md">Transgender</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>Height(in cm)</label>
<input type="text" name="hgt" id="hgt" class="form-control input-md">
</div>
</div>
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>Weight(in kg)</label>
<input type="text" name="wgt" id="wgt" class="form-control input-md">
</div>
</div>
</div>
<div class="row">
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>Symptoms</label>
<input type="text" name="sym" id="sym" class="form-control input-md">
</div>
</div>
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>Disease</label>
<input type="text" name="dis" id="dis" class="form-control input-md">
</div>
</div>
</div>
<div class="row">
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>Days of suffering</label>
<input type="text" name="days" id="days" class="form-control input-md">
</div>
</div>
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>BloodGroup</label>
<input type="text" name="bldgrp" id="bldgrp" class="form-control input-md">
</div>
</div>
</div>
<div class="row">
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>Address</label>
<input type="text" name="addr" id="addr" class="form-control input-md">
</div>
</div>
<div class="col-xs-6 col-sm-6 col-md-6">
<div class="form-group">
<label>Phone Number</label>
<input type="Phone" name="phn" id="phn" class="form-control input-md">
</div>
</div>
</div>
<input type="submit" value="Register" class="btn btn-skin btn-block btn-lg">
</form>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</section>
<!-- /Section: intro -->
<!-- /Section: testimonial -->
<footer>
<div class="container">
<div class="row">
<div class="col-sm-6 col-md-4">
<div class="wow fadeInDown" data-wow-delay="0.1s">
<div class="widget">
<h5>About Health Monitor</h5>
<p>
It is a best place to get the treatment.
</p>
</div>
</div>
</div>
<div class="col-sm-6 col-md-4">
<div class="wow fadeInDown" data-wow-delay="0.1s">
<div class="widget">
<h5>Health Monitor center</h5>
<p>
This is present in many cities across the globe
</p>
<ul>
<li>
<span class="fa-stack fa-lg">
<i class="fa fa-circle fa-stack-2x"></i>
<i class="fa fa-calendar-o fa-stack-1x fa-inverse"></i>
</span> Monday - Sunday, 24 hour service
</li>
<li>
<span class="fa-stack fa-lg">
<i class="fa fa-circle fa-stack-2x"></i>
<i class="fa fa-phone fa-stack-1x fa-inverse"></i>
</span> +62 007 43 221
</li>
<li>
<span class="fa-stack fa-lg">
<i class="fa fa-circle fa-stack-2x"></i>
<i class="fa fa-envelope-o fa-stack-1x fa-inverse"></i>
</span> hello@healthmonitor.com
</li>
</ul>
</div>
</div>
</div>
<div class="col-sm-6 col-md-4">
<div class="wow fadeInDown" data-wow-delay="0.1s">
<div class="widget">
<h5>Our locations</h5>
<p>Mumbai<br>Hyderabad<br>Chennai<br>Delhi<br>Bengaluru</p>
</div>
</div>
</div>
</div>
</div>
<div class="sub-footer">
<div class="container">
<div class="row">
<div class="col-sm-6 col-md-6 col-lg-6">
<div class="wow fadeInLeft" data-wow-delay="0.1s">
<div class="text-left">
<p>©Copyright 2021 - Health Tracker. All rights reserved.</p>
</div>
</div>
</div>
</div>
</div>
</div>
</footer>
</div>
<a href="#" class="scrollup"><i class="fa fa-angle-up active"></i></a>
<!-- Core JavaScript Files -->
<script src="js/jquery.min.js"></script>
<script src="js/bootstrap.min.js"></script>
<script src="js/jquery.easing.min.js"></script>
<script src="js/wow.min.js"></script>
<script src="js/jquery.scrollTo.js"></script>
<script src="js/jquery.appear.js"></script>
<script src="js/stellar.js"></script>
<script src="plugins/cubeportfolio/js/jquery.cubeportfolio.min.js"></script>
<script src="js/owl.carousel.min.js"></script>
<script src="js/nivo-lightbox.min.js"></script>
<script src="js/custom.js"></script>
</body>
</html>