forked from gauravpaliwal/General-Feedback-Module-OpenMRS
/
addFeedbackForm.jsp
47 lines (44 loc) · 1.85 KB
/
addFeedbackForm.jsp
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<%@ include file="local_header.jsp"%>
<h2><spring:message code="feedback.addFeedback"/></h2>
<form method="post" enctype="multipart/form-data">
<b class="boxHeader"><spring:message code="feedback.submit"/></b>
<div class="box" >
<table>
<tr>
<td><spring:message code="feedback.subject"/> </td>
<td>
<select name="subject">
<c:forEach items="${predefinedsubjects}" var="predefinedsubjectObj" >
<option value="<c:out value="${predefinedsubjectObj.subject}"/>"> <c:out value="${predefinedsubjectObj.subject}"/> </option>
</c:forEach>
</select>
</td>
</tr>
<tr>
<td><spring:message code="feedback.severity"/> </td>
<td>
<select name="severity">
<c:forEach items="${severities}" var="severityObj">
<option value="<c:out value="${severityObj.severity}"/>"> <c:out value="${severityObj.severity}"/> </option>
</c:forEach>
</select>
</td>
</tr>
<tr>
<td valign="top"><spring:message code="feedback.feedback"/> </td>
<td><textarea name="feedback" rows="10" cols="120" type="_moz" size="35"></textarea> </td>
</tr>
<tr>
<td><spring:message code="feedback.pageContext"/> </td>
<td><input type="checkbox" name="pagecontext"> </input> </td>
</tr>
<tr>
<td><spring:message code="feedback.attachment"/> </td>
<td><input type="file" accept="image" name="file" size="40" > </input> </td>
</tr>
</table>
<br/>
<input type="submit" value="<spring:message code="feedback.addFeedback" />" />
</div>
</form>
<%@ include file="/WEB-INF/template/footer.jsp" %>