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appointment.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<link rel="stylesheet" href="appointment.css">
<link rel="stylesheet" href="https://unicons.iconscout.com/release/v4.0.0/css/line.css">
<title>Health-Buddy - Shedule appointment </title>
</head>
<body>
<div class="container">
<header>Appointment</header>
<form
action="https://formspree.io/f/mayzlqkj"
method="POST"
>
<div class="form first">
<div class="details personal">
<span class="title">Patient Details</span>
<div class="fields">
<div class="input-field">
<label>Full Name</label>
<input type="text" name="Full Name" placeholder="Enter your name" required>
</div>
<div class="input-field">
<label>Date of Birth</label>
<input type="date" name="Date of Birth" placeholder="Enter birth date" required>
</div>
<div class="input-field">
<label>Email</label>
<input type="email" name="Email" placeholder="Enter your email" required>
</div>
<div class="input-field">
<label>Mobile Number</label>
<input type="number" name="Mobile Number" placeholder="Enter mobile number" required>
</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>Occupation</label>
<input type="text" name="Occupation" placeholder="Enter your ccupation" required>
</div>
</div>
</div>
<div class="details ID">
<span class="title">Appointment Details</span>
<div class="fields">
<div class="input-field">
<label>Department</label>
<select name="Department" required>
<option disabled selected>Select Department</option>
<option>Cardiology</option>
<option>Neurology</option>
<option>Oncology</option>
<option>Orthopedics</option>
<option>Pediatrics</option>
<option>Radiology</option>
<option>Gynecology</option>
<option>Ophthalmology</option>
<option>Dermatology</option>
<option>Psychiatry</option>
<option>Anesthesiology</option>
<option>Endocrinology</option>
<option>Rheumatology</option>
<option>Urology</option>
</select>
</div>
<div class="input-field">
<label>Location</label>
<input type="text" name="Location" placeholder="Enter preffered location" required>
</div>
<div class="input-field">
<label>History</label>
<input type="text" name="History" placeholder="Enter previous medical history" required>
</div>
<div class="input-field">
<label>Issue</label>
<input type="text" name="Issue" placeholder="Enter current health issue" required>
</div>
<div class="input-field">
<label>Date</label>
<input type="date" name="Date" placeholder="Select appointment date" required>
</div>
<div class="input-field">
<label>Time</label>
<input type="time" name="Time" placeholder="Choose preffered time" required>
</div>
</div>
<button class="nextBtn" type="submit">
<span class="btnText">Submit</span>
<i class="uil uil-navigator"></i>
</button>
</div>
</div>
</form>
</div>
<!-- <script src="script.js"></script> -->
</body>
</html>