-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathnew_doc.html
112 lines (89 loc) · 4.06 KB
/
new_doc.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
<!doctype html>
<html>
<head>
<title>medical cloud-set</title>
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="http://code.jquery.com/mobile/1.2.0/jquery.mobile-1.2.0.min.css">
<script src="http://code.jquery.com/jquery-1.8.2.min.js"></script>
<script src="http://code.jquery.com/mobile/1.2.0/jquery.mobile-1.2.0.min.js"></script>
<style type="text/css">
.c_col{
border-top:1px solid #ccc;
}
.ui-block-a, .ui-block-b, .ui-block-c, .ui-block-d, .ui-block-e{
padding-top:5px;
padding-bottom: 5px;
font-size: 12px;
}
</style>
<script type="text/javascript" src="https://ajax.googleapis.com/ajax/libs/jquery/1/jquery.min.js">
</script>
<script src ="http://code.jquery.com/jquery-1.9.1.min.js"></script>
<script type="text/javascript">
$(document).ready(function () {
$("#repwd").keyup(checkPasswordMatch);
function checkPasswordMatch() {
var password = $("#pwd").val();
var confirmPassword = $("#repwd").val();
if (password != confirmPassword)
$("#divCheckPasswordMatch").html("Passwords do not match!");
else
$("#divCheckPasswordMatch").html("Passwords match.");
}
});
</script>
</head>
<body>
<div data-role="page" id="one">
<div data-role="header" data-theme="b">
<h1 style="font-size:1.3em;line-height:1.3em;">Login</h1>
</div><!-- /header -->
<div data-role="content">
<div class="c_content_body">
<h4 style="text-align:center">Please fill in the information below</h4>
<form action ="http://lit-journey-1188.herokuapp.com/doc_details.php" method ="post" data-ajax = "false" >
<label for="doc_name">Name</label>
<input type ="text" name="doc_name" data-clear-btn="true" id="doc_name" value=""/><br>
<label for="doc_id">ID</label>
<input type ="text" name="id" data-clear-btn="true" id="id" value=""/><br>
<label for="spec">Speciality</label>
<input type ="text" name="spec" data-clear-btn="true" id="spec" value=""/><br>
<label for="age">Age</label>
<input type ="text" name="age" data-clear-btn="true" id="age" value=""/><br>
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Sex:</legend>
<input type="radio" name="sex" id="male" value="male" checked="checked">
<label for="male">Male</label>
<input type="radio" name="sex" id="female" value="female">
<label for="female">Female</label>
</fieldset>
<label for="phno">Contact Number</label>
<input type ="text" name="phno" id="phno" data-clear-btn="true" value=""/><br>
<label for="loc">Location</label>
<input type ="text" name="loc" id="loc" data-clear-btn="true" value=""/><br>
<label for="time">Time</label>
<input type ="text" name="time" id="time" data-clear-btn="true" value=""/><br>
<label for="cap">Capacity</label>
<input type ="text" name="cap" id="cap" data-clear-btn="true" value=""/><br>
<label for="add">Addres</label>
<textarea name="add" id="add" data-clear-btn="true"></textarea><br>
<label for="uname">User name</label>
<input type ="text" name="uname" id="uname" data-clear-btn="true" value=""/><br>
<div class="td">
<label for="pwd">Password</label>
<input type ="password" name="pwd" data-clear-btn="true" id="pwd" value=""/><br>
</div>
<div class = "td">
<label for="repwd">Retype Password</label>
<input type ="password" name="repwd" data-clear-btn="true" id="repwd" value="" onChange="checkPasswordMatch();"/><br>
</div>
<div class="registrationFormAlert" id="divCheckPasswordMatch">
</div>
<input type="submit" value="Submit" data-theme="b" data-icon="check" data-iconpos="right" data-inline="true" >
</div><!-- /content -->
<br><div data-role="footer" data-theme="b">
<p style="text-align:center">Medical Cloud</p>
</div><!-- /footer -->
</div><!-- /page -->
</body>
</html>