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book.php
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book.php
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<?php
session_start();
//include funtion.php file
require('function.php');
$con = con();
$id = validate($_POST["id"]);
?>
<!DOCTYPE html>
<html lang="en">
<head>
<style type="text/css">
* {
margin: 0;
padding: 0;
}
body {
font-family: Calibri;
}
h3
{
font-weight: 300;
font-size: 4em;
color: #fff;
background-color: #EAECEE;
padding: 10px 0 20px 10px;
margin-bottom: 50px;
}
h2 {
font-weight: 300;
font-size: 4em;
color: #fff;
background-color: #071d36;
padding: 10px 0 20px 10px;
margin-bottom: 1px;
border-left: 6px solid red;
}
.mySlides {display:none;}
</style>
<title>Health center</title>
<meta charset="utf-8" name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="./assets/css/bootstrap.min.css">
<link href="./assets/css/font-awesome.css" rel="stylesheet">
<link href="./assets/css/blog_page.css" rel="stylesheet">
<link href="./assets/fonts/font.css" rel="stylesheet">
<link href="./assets/css/index.css" rel="stylesheet">
<link href="themes/1/js-image-slider.css" rel="stylesheet" type="text/css" />
<script src="themes/1/js-image-slider.js" type="text/javascript"></script>
<link href="generic.css" rel="stylesheet" type="text/css" />
<script src="./assets/js/jquery.min.js"></script>
<script src="./assets/js/jquery.min1.js"></script>
<script src="./assets/js/bootstrap.min.js"></script>
<script>
function ncheck()
{
var na,nc,n;
nc=/^[a-zA-Z ]+$/;
n=document.getElementById("na");
na=document.getElementById("na").value;
if(!n.value.match(nc) || na.charAt(0)==' ')
{
document.getElementById("spn").innerHTML="Invalid Name";
}
else
{
document.getElementById("spn").innerHTML="";
}
}
function uscheck()
{
var na,nc,n;
n=document.getElementById("na");
na=document.getElementById("na").value;
if(!n.value.match(nc) || na.charAt(0)==' ')
{
document.getElementById("spn").innerHTML="Not blank";
}
else
{
document.getElementById("spn").innerHTML="";
}
}
function mncheck()
{
var mna,mnc,mn;
mnc=/^[a-zA-Z ]+$/;
mn=document.getElementById("mna");
mna=document.getElementById("mna").value;
if(!mn.value.match(mnc) || mna.charAt(0)==' ')
{
document.getElementById("mspn").innerHTML="";
}
else
{
document.getElementById("mspn").innerHTML="";
}
}
function lncheck()
{
var lna,lnc,ln;
lnc=/^[a-zA-Z ]+$/;
ln=document.getElementById("lna");
lna=document.getElementById("lna").value;
if(!ln.value.match(lnc) || lna.charAt(0)==' ')
{
document.getElementById("lspn").innerHTML="Invalid Name";
}
else
{
document.getElementById("lspn").innerHTML="";
}
}
function echeck()
{
var ea,ec;
ec=/^[a-zA-Z0-9._-]+@[a-zA-Z0-9]+.[a-zA-Z.]{2,6}$/;
ea=document.getElementById("ea");
if(!ea.value.match(ec))
{
document.getElementById("spe").innerHTML="Invalid Email";
}
else
{
document.getElementById("spe").innerHTML="";
}
}
function pcheck()
{
var co,pc;
pc=/^[0-9]{10,10}$/;
co=document.getElementById("co");
if(!co.value.match(pc))
{
document.getElementById("spp").innerHTML="Invalid Phone";
}
else
{
document.getElementById("spp").innerHTML="";
}
}
</script>
</head>
</head>
<body style="background-image:url(back/01.jpg) ;background-repeat:no-repeat;background-attachment: fixed;">
<div style="background-color:none;">
<!-- Static navbar -->
<nav class="navbar navbar-inverse navbar-fixed-top">
<div class="container">
<div class="navbar-header">
<button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#myNavbar">
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
<a class="navbar-brand" href="#"><?php echo "MNNIT Health Center" ;?></a>
</div>
<div class="collapse navbar-collapse" id="myNavbar">
<ul class="nav navbar-nav">
<li class="active"><a href="index.php">Home</a></li>
<li class="active" data-toggle="modal" data-target="#add_blog_modal"><a href="search.php">Search Doctor</a></li>
<li class="active"><a href="appoint.php">Book Appointment</a></li>
<li class="active"><a href="login.php">Member login</a></li>
</ul>
</div>
</div>
</nav>
<br><br>
<!-- End-->
<div class="container">
<div id="signupbox" style="margin-top:50px" class="mainbox col-md-6 col-md-offset-3 col-sm-8 col-sm-offset-3">
<div class="panel panel-info">
<div class="panel-heading">
<div class="panel-title">Please Fill your details</div>
<div style="float:right; font-size: 85%; position: relative; top:-10px"><a id="signinlink" href="appoint.php">Again select Disease</a></div>
</div>
<div class="panel-body" >
<form style="background-image:url(back/10.jpg);" id="book" class="form-horizontal" role="form" action="book_backend.php" method="post">
<div class="form-group">
<label for="first_name" class="col-md-3 control-label">First Name *</label>
<div class="col-md-9">
<input type="text" class="form-control" name="first_name" placeholder="First Name" size="30" id="na" onblur="ncheck();"><span id="spn" style="color:red"></span>
</div>
</div>
<div class="form-group">
<label for="middle_name" class="col-md-3 control-label">Middle Name</label>
<div class="col-md-9">
<input type="text" class="form-control" name="middle_name" placeholder="Middle Name" size="30" id="mna" onblur="mncheck();"><span id="mspn" style="color:red"></span>
</div>
</div>
<div class="form-group">
<label for="last_name" class="col-md-3 control-label">Last Name</label>
<div class="col-md-9">
<input type="text" class="form-control" name="last_name" placeholder="Last Name" size="30" id="lna" onblur="lncheck();"><span id="lspn" style="color:red"></span>
</div>
</div>
<div class="form-group">
<label for="user_id" class="col-md-3 control-label">User Id *</label>
<div class="col-md-9">
<input type="text" class="form-control" name="user_id" placeholder="User Id" id="na" onblur="uscheck();"><span id="spn" style="color:red"></span>
</div>
</div>
<div class="form-group">
<label for="email" class="col-md-3 control-label">Email *</label>
<div class="col-md-9">
<input type="text" class="form-control" name="email" placeholder="Email Address" id="ea" onblur="echeck();"><span id="spe" style="color:red"></span>
</div>
</div>
<div class="form-group">
<label for="mo" class="col-md-3 control-label">Mo. Number *</label>
<div class="col-md-9">
<input type="text" class="form-control" name="mo" placeholder="Mobile number" id="co" onblur="pcheck();" maxlength="10"><span id="spp" style="color:red"></span>
</div>
</div>
<div class="form-group">
<label for="mo" class="col-md-3 control-label">Select Your disease *</label>
<div class="col-md-9">
<select class="form-control" name="di">
<option>Choice</option>
<option>Acne</option>
<option>Allergy</option>
<option>Altitude sickness</option>
<option>Asthma</option>
<option>Back Pain</option>
<option>Headache</option>
<option>AIDS</option>
<option>Hypertension</option>
<option>Influenza</option>
<option>diabetes</option>
<option>Muscle Pain</option>
<option>Cold fever</option>
</select>
</div>
</div>
<div class="form-group">
<label for="add1" class="col-md-3 control-label">Address Line1 *</label>
<div class="col-md-9">
<input type="text" class="form-control" placeholder="Line 1" name="add1" id="na" onblur="uscheck();"><span id="spn" style="color:red"></span>
</div>
</div>
<div class="form-group">
<label for="add2" class="col-md-3 control-label">Address Line2</label>
<div class="col-md-9">
<input type="text" class="form-control" name="add2" placeholder="Line 2">
</div>
</div>
<div class="form-group">
<label for="add3" class="col-md-3 control-label">Address Line3</label>
<div class="col-md-9">
<input type="text" class="form-control" name="add3" placeholder="Line 3">
</div>
</div>
<input type="text" name="did" style="display:none"value=" <?php echo $id ?>">
<br>
<!--Reset Button -->
<div class="form-group">
<div class=" col-md-offset-4 col-md-2">
<input type="reset" id="btn-reset" class="btn btn-info"><i class="icon-hand-right" value="Reset" onclick="#"></i>
</div>
<!--Submit Button -->
<div class="col-md-offset-2 col-md-2">
<input type="submit" id="btn-signup" class="btn btn-info"><i class="icon-hand-right"></i>
</div>
</div>
<br><br>
</form>
</div>
</div>
</div>
</div>
</div>
<br><br><br><br>
<footer class="container-fluid">
<div style="text-align:center;padding:1%;font-weight:bold">
devloped By Choubeyji © 2018
</div>
</footer>
</body>
</html>