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Bloodbank_registration.php
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Bloodbank_registration.php
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<!DOCTYPE html>
<html lang="en">
<!-- Basic -->
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<!-- Mobile Metas -->
<meta name="viewport" content="width=device-width, initial-scale=1">
<meta name="viewport" content="initial-scale=1, maximum-scale=1">
<!-- Site Metas -->
<title>Life Line</title>
<meta name="keywords" content="">
<meta name="description" content="">
<meta name="author" content="">
<!-- Site Icons -->
<link rel="shortcut icon" href="images/fevicon.ico.png" type="image/x-icon" />
<link rel="apple-touch-icon" href="images/apple-touch-icon.png">
<!-- Bootstrap CSS -->
<link rel="stylesheet" href="css/bootstrap.min.css">
<!-- Site CSS -->
<link rel="stylesheet" href="style.css">
<!-- Colors CSS -->
<link rel="stylesheet" href="css/colors.css">
<!-- ALL VERSION CSS -->
<link rel="stylesheet" href="css/versions.css">
<!-- Responsive CSS -->
<link rel="stylesheet" href="css/responsive.css">
<!-- Custom CSS -->
<link rel="stylesheet" href="css/custom.css">
<!-- Modernizer for Portfolio -->
<script src="js/modernizer.js"></script>
<!-- [if lt IE 9] -->
</head>
<body class="clinic_version">
<!-- LOADER -->
<div id="preloader">
<img class="preloader" src="images/loaders/heart-loading2.gif" alt="">
</div>
<!-- END LOADER -->
<header>
<div class="header-top wow fadeIn">
<div class="container">
<a class="navbar-brand" href="index.php"><img src="images/logo1.png" alt="image"></a>
<div class="right-header">
</div>
</div>
</div>
<div class="header-bottom wow fadeIn">
<div class="container">
<nav class="main-menu">
<div class="navbar-header">
<button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-target="#navbar" aria-expanded="false" aria-controls="navbar"><i class="fa fa-bars" aria-hidden="true"></i></button>
</div>
<div id="navbar" class="navbar-collapse collapse">
<ul class="nav navbar-nav">
<li><a class="active" href="index.php">Return to Home</a></li>
<!-- Return to home link -->
</ul>
</div>
<div class=col-4>
</div>
</nav>
</div>
</div>
<div id="service" class="services wow fadeIn">
<div class="col-lg-16 col-md-15 col-sm-19 col-xs-15">
<h2>Donate Blood!</h2>
<div class="appointment-form">
<h3><span></span>Blood bank registration</h3>
<div class="form">
<form method="post" action="sample/patient.php">
<fieldset>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="row">
<div class="form-group">
<input type="text" id="firstName" name="userID" placeholder="First Name" />
</div>
</div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="row">
<div class="form-group">
<input type="text" id="lastName" name="lastName" placeholder="Last Name" />
</div>
</div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="row">
<div class="form-group">
<input type="number_format" id="phone" name="password" placeholder="Phone Number" />
</div>
</div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="row">
<div class="form-group">
<input type="text" id="group" name="bloodGroup" placeholder="Blood Group" />
</div>
</div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="row">
<div class="form-group">
<input type="text" id="location" name="locations" placeholder="Enter the location" />
</div>
</div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="row">
<div class="form-group">
<div class="center"><button type="submit">Submit</button></div>
</div>
</div>
</div>
</fieldset>
</form>
</div>
</div>
</div>
<!-- end copyrights -->
<a href="#home" data-scroll class="dmtop global-radius"><i class="fa fa-angle-up"></i></a>
<!-- all js files -->
<script src="js/all.js"></script>
<!-- all plugins -->
<script src="js/custom.js"></script>
<!-- map -->
<script src="https://maps.googleapis.com/maps/api/js?key=AIzaSyCNUPWkb4Cjd7Wxo-T4uoUldFjoiUA1fJc&callback=myMap"></script>
</body>
</html>