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form.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>User Details Form</title>
<!-- Bootstrap CSS -->
<link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/bootstrap-icons@1.11.1/font/bootstrap-icons.css" integrity="sha384-4LISF5TTJX/fLmGSxO53rV4miRxdg84mZsxmO8Rx5jGtp/LbrixFETvWa5a6sESd" crossorigin="anonymous">
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.5.2/css/all.min.css">
<link rel="stylesheet" href="bootstrap.css">
<link rel="stylesheet" href="style.css">
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.5.2/css/bootstrap.min.css">
<!-- Custom CSS -->
<style>
body {
background-color: #f8f9fa;
padding-top: 50px;
}
.container {
background-color: #fff;
border-radius: 10px;
box-shadow: 0px 0px 10px rgba(0, 0, 0, 0.1);
padding: 30px;
}
.container h2 {
margin-bottom: 30px;
}
label {
font-weight: bold;
}
input[type="text"],
input[type="number"],
input[type="email"] {
width: 100%;
padding: 10px;
border-radius: 5px;
border: 1px solid #ccc;
margin-bottom: 15px;
}
input[type="submit"] {
width: 100%;
padding: 10px;
border: none;
border-radius: 5px;
background-color: #007bff;
color: #fff;
cursor: pointer;
transition: background-color 0.3s;
}
input[type="submit"]:hover {
background-color: #0056b3;
}
h3{
color: rgb(10, 243, 10);
font-weight: bold;
}
#dis {
margin-top: 20px;
font-size: 30px;
margin-left: 165px;
}
img{
width: 100px;
height: 100px;
}
#abc{
display: flex;
flex-direction: row;
}
#abc>h2{
margin-left: 400px;
margin-top: 30px;
}
h1{
text-align: center;
text-decoration: underline;
color: red;
}
</style>
</head>
<body>
<script src="https://cdn.botpress.cloud/webchat/v1/inject.js"></script>
<script src="https://mediafiles.botpress.cloud/acd78299-0c42-4113-a432-eb31e794a8a2/webchat/config.js" defer></script>
<nav class="navbar navbar-expand-lg navbar-light bg-light ">
<div class="container-fluid">
<a href="#" class="navbar-brnad">
<img src= "22.png" height="75">
</a>
<button type="button" class="navbar-toggler" data-bs-toggle= "collapse" data-bs-target="#navbar1">
<i class="bi bi-list"></i>
</button>
<div class="collapse navbar-collapse" id="navbar1">
<div class="navbar-nav ms-auto">
<a href="index.html" class="nav-item nav-link active">Home</a>
<!--<div class="nav-item dropdown">
<a href="#" class="nav-link dropdown-toggle" data-bs-toggle="dropdown">About Us</a>
<div class="dropdown-menu">
<a href="#" class="dropdown-item">Company</a>
<a href="#" class="dropdown-item">Team</a>
</div>
</div>-->
<a href="aboutus.html" class="nav-item nav-link active">About Us</a>
<a href="#contactus" class="nav-item nav-link active">Contact Us</a>
<a href="physicians.html" class="nav-item nav-link active">Physician</a>
<a href="login.html" class="nav-item nav-link active">Login</a>
<a href="form.html" class="nav-item nav-link active">CheckUp</a>
</div>
</div>
</div>
</nav>
<div class="container">
<div id="abc">
<img src="WhatsApp_Image_2024-04-20_at_10.41.33-removebg-preview (1).png" alt="">
<h2>User Details Form</h2>
</div>
<form id="userForm">
<div class="row">
<div class="col-md-6">
<label for="name">Name:</label>
<input type="text" class="form-control" id="name" name="name">
</div>
<div class="col-md-6">
<label for="Contact">Contact No:</label>
<input type="number" class="form-control" id="Contact" name="Contact">
</div>
</div>
<div class="row">
<div class="col-md-6">
<label for="email">Email:</label>
<input type="email" class="form-control" id="email" name="email">
</div>
<div class="col-md-6">
<label for="Gender">Gender:</label>
<input type="text" class="form-control" id="Gender" name="Gender">
</div>
</div>
<div class="row">
<div class="col-md-6">
<label for="Age">Age:</label>
<input type="number" class="form-control" id="Age" name="Age">
</div>
<div class="col-md-6">
<label for="Height">Height:</label>
<input type="number" class="form-control" id="Height" name="Height">
</div>
</div>
<div class="row">
<div class="col-md-6">
<label for="Weight">Weight:</label>
<input type="number" class="form-control" id="Weight" name="Weight">
</div>
<div class="col-md-6">
<label for="Haemoglobin">Haemoglobin Alc(HbALc):</label>
<input type="number" class="form-control" id="Haemoglobin" name="Haemoglobin">
</div>
</div>
<div class="row">
<div class="col-md-6">
<label for="Systolic Bp">Systolic Bp:</label>
<input type="number" class="form-control" id="Systolic" name="Systolic">
</div>
<div class="col-md-6">
<label for="Diastolic Bp">Diastolic Bp:</label>
<input type="number" class="form-control" id="Diastolic" name="Diastolic">
</div>
</div>
<div class="row">
<div class="col-md-6">
<label for="Spyrometry">Spirometry:</label>
<input type="number" class="form-control" id="Spyrometry" name="Spyrometry">
</div>
<div class="col-md-6">
<label for="Gfr">Glomelular Filtration Rate:</label>
<input type="number" class="form-control" id="Gfr" name="Gfr">
</div>
</div>
<div class="row">
<div class="col-md-6">
<label for="DEXA">DEXA Scans:</label>
<input type="number" class="form-control" id="DEXA" name="DEXA">
</div>
</div>
<div class="row">
<div class="col-md-12">
<input type="submit" class="btn btn-primary" value="Submit">
</div>
</div>
</form>
</div>
<div id="dis"></div>
</div>
<div id="dis">
</div>
<script src="https://cdn.jsdelivr.net/npm/@popperjs/core@2.5.3/dist/umd/popper.min.js"></script>
<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.5.2/js/bootstrap.min.js"></script>
<script src="main.js"></script>
<!-- Your custom JavaScript goes here -->
</body>
</html>