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quickappointment.html
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quickappointment.html
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<html>
<head>
<title>Make An Appointment</title>
<link rel = "stylesheet" href = "css/quickappointment.css" />
<script language="Javascript" type="text/javascript">
function onlyAlphabets(e, t) {
try {
if (document.event) {
var charCode = document.event.keyCode;
}
else if (e) {
var charCode = e.which;
}
else { return true; }
if ((charCode > 64 && charCode < 91) || (charCode > 96 && charCode < 123))
return true;
else
return false;
}
catch (err) {
alert(err.Description);
}
}
function onlyNumbers(e, t) {
try {
if (document.event) {
var charCode = document.event.keyCode;
}
else if (e) {
var charCode = e.which;
}
else { return true; }
if ((charCode > 47 && charCode < 58)
return true;
else
return false;
}
catch (err) {
alert(err.Description);
}
}
</script>
</head>
<body>
<div id = "appointment1">
<header>
<img src = "img/logo.png" alt = "Logo" />
<h1>NMIT HOSPITALS</h1>
<h2>A One-Stop Solution To Keep You Healthy</h2>
</header>
</div>
<div id = "appointment2">
<br />
<form action = "quickappointmentprocessing.php" method = "post">
<h2>Patient Information:</h2>
<label for = "fname">Legal First Name:</label>
<input type = "text" id = "fname" name = "firstname" placeholder = "Your name...(Mandatory)" maxlength = "50" pattern = "[A-Za-z]{1,50}" required autocomplete = "off" onkeypress = "return onlyAlphabets(event,this);" />
<label for = "lname">Legal Last Name:</label>
<input type = "text" id = "lname" name = "lastname" placeholder = "Your last name...(Mandatory)" maxlength = "50" pattern = "[A-Za-z]{1,50}" required autocomplete = "off" onkeypress = "return onlyAlphabets(event,this);" />
<label for = "contact">Mobile Number:</label>
<input type = "text" id = "contact" name = "contact" placeholder = "Your mobile number...(Mandatory)" maxlength = "10" pattern = "[0-9]{10}" required autocomplete = "off" onkeypress = "return onlyNumbers(event,this);" />
<label for = "doctorid">Employee ID of the doctor whose appointment you need:</label>
<input type = "text" id = "doctorid" name = "doctorid" maxlength = "5" pattern = "[0-9]{1,5}" placeholder = "Employee ID...(Mandatory)" required autocomplete = "off" onkeypress = "return onlyNumbers(event,this);" />
<input type = "submit" name = "submit" value= "Send Request" />
</form>
</div>
<div id = "appointment3">
<footer>
<ul>
<li>Contact number: 080-23450917, 080-23450918, 080-23450919, 080-23334565</li>
<li>© NMIT Foundation for Medical Education and Research (NMITMER). All rights reserved.</li>
</ul>
</footer>
</div>
</body>
</html>