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form.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="icon" href="favIcon/favicon-32x32.png" type="image/gif" >
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css" />
<link rel="stylesheet" href="form.css" />
<title>Registration</title>
</head>
<body>
<div class="container">
<div class="arrow">
<abbr title="Back"><a href="index.html"><i class="fa fa-arrow-circle-left"></i></a></abbr>
</div>
<div class="name">
<p>slot<span>.alert</span></p>
</div>
<div class="formLeft">
<div class="forms">
<h1>Enter Your <span>Details</span></h1>
<form method="GET" id="registration-form">
<label class="para" for="name">Name</label>
<input class="inputTaker" type="text" name="name" id="name" autocomplete="off" placeholder="eg.Rakesh"/>
<span class="error" id="namingError"></span><br /><br />
<label class="para" for="ph_num">phone number</label>
<input class="inputTaker" type="phone" name="ph_num" id="ph_num" autocomplete="off" placeholder="eg.975****000"/>
<span class="error" id="phoneNumError"></span><br /><br />
<label class="para" for="pin_code">pin code</label>
<input class="inputTaker" type="text" name="pin_code" id="pin_code" autocomplete="off" placeholder="eg.2631**" />
<span class="error" id="pinCodeError"></span><br>
<p class="para">date :</p>
<div class="radio">
<input type="radio" onclick="dateHandler()" id="forDate" name="date" value="select date" />
<label for="forDate">Specific day alert</label>
</div>
<div class="date" id="datediv">
<label for="dates">select date:</label>
<input class="dateField" type="date" id="dates" name="date" ><br>
<span class="error" id="dateError"></span>
</div>
<div class="radio">
<input type="radio" onclick="withOutDateHandler()" id="forNoDate" name="date" value="without date"
/>
<label for="forNoDate">Daily alert</label>
</div>
<span class="error" id="radioButtonError"></span>
<br />
<div class="btn">
<input class="submits" type="submit" value="register now" name="submit" />
</div>
</form>
</div>
</div>
<div class="formRight">
<img src="images/output2.png" alt="doctor_img " />
</div>
</div>
<div class="footer">
<div class="text">
<p>made with <i class="fa fa-heart"></i> by : tarun & lalit</p>
</div>
<div class="copyright_line">
<p>copyright <i class="fa fa-copyright"> </i> all rights reserved</p>
</div>
</div>
</body>
<script src="form.js"></script>
</html>