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signup.html
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<html>
<head>
<meta charset="utf-8">
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<link rel="stylesheet" href="/css/font.css">
<link rel="shortcut icon" href="/favicon.ico" type="image/x-icon">
<meta name="viewport" content="width=device-width, initial-scale=1.0"> <link rel="stylesheet" href="https://fonts.googleapis.com/css2?family=Material+Symbols+Outlined:opsz,wght,FILL,GRAD@48,400,0,0" />
<title>Sign Up | RV Hospitals❤️🩹</title>
<link rel="stylesheet" href="https://unicons.iconscout.com/release/v4.0.0/css/line.css">
<style>
@import url('https://fonts.googleapis.com/css2?family=Poppins:wght@200;300;400;500;600&display=swap');
</style>
<style type="text/css">
*{
box-sizing: content-box;
font-family: 'Poppins', sans-serif;
}
input,select,a{
font-family: 'Poppins', sans-serif;
border-radius: 6px;
height: 30px;
}
textarea{
font-family: 'Poppins', sans-serif;
border-radius: 6px;
}
.btn{
background-color: white;
color: black;
border: 2px solid #4070f4;
font-size: 14px;
font-weight: 500;
border-radius: 5px;
position: relative;
transition-duration: 0.6s;
padding: 5px 20px;
font-weight: bold;
}
.btn:hover{
background-color: #4070f4;
color: white;
box-shadow: 0 5px 10px rgba(0,0,0,0.1);
}
body{
min-height: 10vh;
display: flex;
align-items: center;
justify-content: center;
background: #4070f4;
}
.top{
position: relative;
max-width: 1000px;
border-radius: 36px;
padding: 30px;
margin: 0 15px;
background-color: #fff;
box-shadow: 0 5px 10px rgba(0,0,0,0.5);
}
.fields{
display: flex;
align-items: center;
justify-content: space-between;
flex-wrap: wrap;
}
.top form{
position: relative;
margin-top: 16px;
background-color: #fff;
overflow: hidden;
}
form .fields .input-field{
display: flex;
width: calc(100% / 2 - 25px);
flex-direction: column;
margin: 3px 0;
}
.button{
margin-top: 20px;
}
header{
margin-top: -30px;
}
@media (max-width: 750px) {
.till form{
overflow-y: scroll;
}
.till form::-webkit-scrollbar{
display: none;
}
form .fields .input-field{
width: calc(100% / 2 - 15px);
}
}
@media (max-width: 550px) {
form .fields .input-field{
width: 100%;
}
}
</style>
</head>
<body>
<div class="top">
<header><h2>Fillout The Details</h2></header>
<div class="till">
<div id="details">
<form name="signup" method="post" action="/signup">
<div class="fields">
<div class="input-field">
<label>First Name</label>
<input type="text" name="firstname" pattern="[A-Za-z -]+" placeholder="Enter your Name (only alphabets)" required autofocus>
</div>
<div class="input-field">
<label>Last Name</label>
<input type="text" name="secondname" pattern="[A-Za-z -]+" placeholder="Enter your Last Name (only alphabets)" required>
</div>
<div class="input-field">
<label>Email</label>
<input type="email" name="email" required pattern="[a-z0-9._%+-]+@[a-z0-9.-]+\.[a-z]{2,}$" placeholder="Enter your Email" required>
</div>
<div class="input-field">
<label>Date of Birth</label>
<input type="date" name="dob" placeholder="Enter Birth Date" required>
</div>
<div class="input-field">
<label>Mobile Number</label>
<input type="tel" name="phone" pattern="[0-9]{10}" placeholder="Enter Mobile Number (only numbers)" required maxlength="10">
</div>
<div class="input-field">
<label>Gender</label>
<select name="gender" required>
<option disabled selected>Select Gender</option>
<option>Male</option>
<option>Female</option>
<option>Others</option>
</select>
</div>
<div class="input-field">
<label>Marital Status</label>
<select name="marital" required>
<option disabled selected>Select Status</option>
<option>Single</option>
<option>Married</option>
</select>
</div>
<div class="input-field">
<label>Occupation</label>
<input type="text" name="occupation" placeholder="Enter your Occupation" required>
</div>
<div class="input-field">
<label>Aadhar Number</label>
<input type="tel" name="aadhar" pattern="[0-9]{12}" placeholder="Enter Aadhar Number (only numbers)" required maxlength="12">
</div>
<div class="input-field">
<label>Address</label>
<textarea rows="5" name="address" cols="5" placeholder="Enter Your Address" style="resize: none;"></textarea>
</div>
<div class="input-field">
<label>Blood Group</label>
<select name="blood" required>
<option disabled selected>Select Blood Group</option>
<option selected>B+ve</option>
<option>B-ve</option>
<option>A+ve</option>
<option>A-ve</option>
<option>AB+ve</option>
<option>AB-ve</option>
<option>O+ve</option>
<option>O-ve</option>
</select>
</div>
<div class="input-field">
<label>Height(in cm)</label>
<input type="number" name="height" placeholder="Enter your Height" required min="30" max="220">
</div>
<div class="input-field">
<label>Weight(in kg)</label>
<input type="number" name="weight" placeholder="Enter your Weight" required min="2" max="110">
</div>
<div class="input-field">
<label>BMI</label>
<input type="number" name="bmi" placeholder="Enter your BMI" required min="2" max="110">
</div>
<div class="input-field">
<label>Password</label>
<input type="password" id="pass" name="password" placeholder="Enter your Password" pattern="^(?=.*[A-Z])(?=.*[0-9].*[0-9]).+$" required>
</div>
<div class="input-field">
<label>Confirm Password</label>
<input type="password" id="confirm" name="confirmpassword" placeholder="Enter your Password Once Again" pattern="^(?=.*[A-Z])(?=.*[0-9].*[0-9]).+$" required>
</div>
<div class="input-field">
<label>Designation</label>
<!-- <input type="text" name="designation" placeholder="Enter your Designation" required> -->
<select name="designation" required>
<option value="Patient">Patient</option>
</select>
</div>
<div class="button">
<input type="reset" class="btn" value="Reset">
<input type="submit" class="btn" value="Submit">
<a href="/login" class="btn" style="text-decoration: none;padding: 10px 25px;">Login</a>
</div>
</div>
</form>
</div>
</div>
</div>
</body>
</html>