Darrel Israel
154 lines
6.4 KiB
PHP
154 lines
6.4 KiB
PHP
<!DOCTYPE html>
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<html lang="en">
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<head>
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<meta charset="utf-8" />
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<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no" />
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<title>Dashboard</title>
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<link rel="stylesheet" href="assets/vendors/mdi/css/materialdesignicons.min.css">
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<link rel="stylesheet" href="assets/vendors/flag-icon-css/css/flag-icon.min.css">
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<link rel="stylesheet" href="assets/vendors/css/vendor.bundle.base.css">
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<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.5.0/dist/css/bootstrap.min.css" rel="stylesheet">
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<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.5.0/dist/js/bootstrap.bundle.min.js"></script>
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<link rel="stylesheet" href="path-to-your-css/bootstrap.min.css">
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<script src="path-to-your-js/jquery.min.js"></script>
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<script src="path-to-your-js/bootstrap.min.js"></script>
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<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.5.2/css/bootstrap.min.css">
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<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
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<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.16.0/umd/popper.min.js"></script>
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<script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.5.2/js/bootstrap.min.js"></script>
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<script src='https://kit.fontawesome.com/a076d05399.js' crossorigin='anonymous'></script>
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<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css">
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<link rel="stylesheet" href="assets\css\a.css">
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<link rel="stylesheet" href="assets/vendors/jquery-bar-rating/css-stars.css" />
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<link rel="stylesheet" href="assets/vendors/font-awesome/css/font-awesome.min.css" />
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<link rel="stylesheet" href="assets/css/demo_1/style.css" />
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<link rel="shortcut icon" href="assets/images/favicon.png" />
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<link rel="stylesheet" href="assets\css\number.css">
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</head>
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<body>
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<form action="addappointment.php" method="POST">
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<fieldset class="custom-fieldset">
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<legend>
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<h1><b>Add Appointment</b></h1>
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</legend>
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<!-- First Name -->
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<div>
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<br>
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<label for="firstName">First Name:</label>
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<input class="form-control" type="text" id="firstName" name="fname" placeholder="First Name">
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</div>
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<!-- Middle Name -->
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<div>
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<br>
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<label for="middleName">Middle Name:</label>
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<input class="form-control" type="text" id="middleName" name="mname" placeholder="Middle Name">
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</div>
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<!-- Last Name -->
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<div>
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<br>
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<label for="lastName">Last Name:</label>
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<input class="form-control" type="text" id="lastName" name="lname" placeholder="Last Name">
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</div>
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<!-- Age -->
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<div>
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<br>
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<label for="age">Age:</label>
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<input class="form-control" type="number" id="age" name="age" placeholder="Age" in="0" max="9999999999" inputmode="numeric" pattern="[0-9]*">
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</div>
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<!-- Sex -->
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<div class="nameage">
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<br>
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<label for="sex">Sex:</label>
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<span style="margin-right: 10px;"></span>
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<input type="radio" name="sex" id="male" value="male" checked>
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<label for="male">Male</label>
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<span style="margin-right: 10px;"></span>
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<input type="radio" name="sex" id="female" value="female">
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<label for="female">Female</label>
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<br>
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</div>
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<!-- Civil Status -->
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<div>
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<br>
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<label for="civilStatus">Civil Status:</label>
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<select class="form-control" id="civilStatus" name="civilStatus">
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<option value="Single">Single</option>
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<option value="Married">Married</option>
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<option value="Widowed">Widowed</option>
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<option value="Separated">Separated</option>
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</select>
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</div>
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<!-- Phone Number -->
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<div>
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<br>
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<label for="phoneNum">Phone Number:</label>
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<input class="form-control" type="number" id="phoneNum" name="phonenum" placeholder="Ex. 09123456789" in="0" max="9999999999" inputmode="numeric" pattern="[0-9]*">
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</div>
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<!-- Address -->
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<div>
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<br>
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<label for="phoneNum">Address:</label>
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<input class="form-control" type="text" id="Address" name="address" placeholder="Address">
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</div>
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<!-- Date of Birth -->
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<div class="nameage">
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<br>
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<label for="dateOfBirth">Date Of Birth:</label><br>
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<input type="date" id="dateOfBirth" name="dateOfBirth">
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</div>
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<!-- Type -->
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<div>
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<br>
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<label for="type">Type:</label>
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<select class="form-control" id="type_appointment" name="type_appointment">
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<option value="CheckUp">Check Up</option>
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<option value="FollowUp">Follow Up</option>
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</select>
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</div>
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<div>
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<br>
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<!-- for doctor populate -->
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<label for="FreeDoctor">Doctor:</label>
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<select class="form-control" id="doctor" name="doctor">
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<?php
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require "dbconn.php"; // Include your database connection
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// Query to fetch doctor data from tbldoctor
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$sql = "SELECT doctorid, fname, lname FROM tbldoctor";
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$result = mysqli_query($conn, $sql);
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if ($result) {
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while ($row = mysqli_fetch_assoc($result)) {
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$doctorId = $row['doctorid'];
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$doctorFullName = $row['fname'] . ' ' . $row['lname'];
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echo "<option value='$doctorId'>$doctorFullName</option>";
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}
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}
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?>
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</select>
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</div>
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<div class="modal-footer">
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<button type="submit" class="btn btn-primary" name="btnAddAppointment">Add</button>
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</div>
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</fieldset>
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</form>
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</body>
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</html>
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