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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>Arogya Sampark</title>
<link rel="icon" type="image/png" href="./assets/favicon.png">
<link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css">
<link rel="stylesheet" href="./styling/style.css">
<link rel="stylesheet" href="./styling/sample.css">
</head>
<body>
<nav class="navbar navbar-expand-lg navbar-light bg-transparent">
<button class="navbar-toggler" type="button" data-toggle="collapse" data-target="#navbarNav"
aria-controls="navbarNav" aria-expanded="false" aria-label="Toggle navigation">
<span class="navbar-toggler-icon"></span>
</button>
<div class="collapse navbar-collapse" id="navbarNav">
<ul class="navbar-nav">
<li class="nav-item">
<a class="nav-link" href="./index.html">Home</a>
</li>
<li class="nav-item">
<a class="nav-link" href="./department.html">Departments</a>
</li>
<li class="nav-item">
<a class="nav-link" href="#">Appointment</a>
</li>
<li class="nav-item">
<a class="nav-link" href="./news.html">News</a>
</li>
<li class="nav-item">
<a class="nav-link" href="./contact.html">About Us</a>
</li>
<a class="navbar-brand" href="#">
<img src="./assets/favicon.png" width="35" height="35" class="d-inline-block align-top" alt="">
Arogya Sampark
</a>
</ul>
<ul class="navbar-nav ml-auto">
<li class="nav-item">
<a class="nav-link" href="./login.html">Log In / Sign Up</a>
</li>
<li class="nav-item-emergency">
<a class="nav-link" href="./emergency.html">Emergency</a>
</li>
</ul>
</div>
</nav>
<div id="chatbot">
<div class="search">
<div class="search_box">
<input type="text" class="input" placeholder="Ask me Anything...">
<button type="submit" class="btn">
<img src="./assets/icons8-discord.svg" alt="bot" width="30px">
<p>Search</p>
</button>
</div>
</div>
</div>
<div class="container">
<div class="title">General Appointment</div>
<form action="#">
<div class="user-details">
<div class="input">
<label for="inputHospital">Hospital Name</label>
<select id="inputHospital" class="form-control" autocomplete="off" required>
<option selected>Choose...</option>
<option value="Ruby General Hospital">Ruby General Hospital</option>
<option value="Desun Hospital">Desun Hospital</option>
<option value="Fortis Hospital">Fortis Hospital</option>
</select>
</div>
<div class="input-box" id="nm">
<span class="details">Name</span>
<input id="name" type="text" placeholder="Enter Full Name" required>
</div>
<div class="input-box" id="ph">
<span class="details">Phone Number</span>
<input id="phone" type="tel" placeholder="Enter Phone No." pattern="[0-9]{10}" required>
</div>
<div class="input-box" id="add">
<span class="details">Address</span>
<input id="address" type="text" placeholder="Enter Full Address" required>
</div>
<div class="input-box" id="code">
<span class="details">Pin Code</span>
<input id="pin" type="number" placeholder="Enter Pin Code" required>
</div>
<div class="form-group-2" id="state">
<label for="inputState">State</label>
<select id="inputState" class="form-control" autocomplete="off" required>
<option selected>Choose...</option>
<option value="Andhra Pradesh">Andhra Pradesh</option>
<option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
<option value="Arunachal Pradesh">Arunachal Pradesh</option>
<option value="Assam">Assam</option>
<option value="Bihar">Bihar</option>
<option value="Chandigarh">Chandigarh</option>
<option value="Chhattisgarh">Chhattisgarh</option>
<option value="Dadar and Nagar Haveli">Dadar and Nagar Haveli</option>
<option value="Daman and Diu">Daman and Diu</option>
<option value="Delhi">Delhi</option>
<option value="Lakshadweep">Lakshadweep</option>
<option value="Puducherry">Puducherry</option>
<option value="Goa">Goa</option>
<option value="Gujarat">Gujarat</option>
<option value="Haryana">Haryana</option>
<option value="Himachal Pradesh">Himachal Pradesh</option>
<option value="Jammu and Kashmir">Jammu and Kashmir</option>
<option value="Jharkhand">Jharkhand</option>
<option value="Karnataka">Karnataka</option>
<option value="Kerala">Kerala</option>
<option value="Madhya Pradesh">Madhya Pradesh</option>
<option value="Maharashtra">Maharashtra</option>
<option value="Manipur">Manipur</option>
<option value="Meghalaya">Meghalaya</option>
<option value="Mizoram">Mizoram</option>
<option value="Nagaland">Nagaland</option>
<option value="Odisha">Odisha</option>
<option value="Punjab">Punjab</option>
<option value="Rajasthan">Rajasthan</option>
<option value="Sikkim">Sikkim</option>
<option value="Tamil Nadu">Tamil Nadu</option>
<option value="Telangana">Telangana</option>
<option value="Tripura">Tripura</option>
<option value="Uttar Pradesh">Uttar Pradesh</option>
<option value="Uttarakhand">Uttarakhand</option>
<option value="West Bengal">West Bengal</option>
</select>
</div>
<div class="input-box" id="ag">
<span class="details">Age</span>
<input id="age" type="text" placeholder="Enter Your Age" required>
</div>
<div class="form-group" id="gen">
<label for="gender">Gender</label>
<select id="gender" class="form-control" autocomplete="off" required>
<option selected>Choose...</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
<option value="Other">Other</option>
</select>
</div>
<div class="form-group-2">
<label for="inputDate">Preferred Appointment Date</label>
<input type="date" class="form-control" id="inputDate" placeholder="Enter Preferred Date of Appointment"
autocomplete="off" required>
</div>
<div class="form-group-2">
<label for="category">Choose Department</label>
<select id="category" class="form-control" autocomplete="off" required>
<option selected>Choose...</option>
<option value="General Surgery">General Surgery</option>
<option value="Cardiology">Cardiology</option>
<option value="Neurology">Neurology</option>
<option value="Orthopaedic">Orthopaedic</option>
</select>
</div>
</div>
<button type="submit" class="btn btn-primary">Request Appointment</button>
</form>
</div>
</div>
<script src="https://code.jquery.com/jquery-3.5.1.slim.min.js"></script>
<script src="https://cdn.jsdelivr.net/npm/@popperjs/[email protected]/dist/umd/popper.min.js"></script>
<script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.min.js"></script>
</body>
</html>