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Billing and payment.html
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<!DOCTYPE html>
<html>
<head>
<title>Medical Billing and Payment</title>
<link rel="stylesheet" href="Style Payment form.css">
</head>
<body>
<header>
<h1>Medical Billing and Payment</h1>
<p>Complete your order by providing billing information and selecting a payment method.</p>
</header>
<section>
<h2>Billing Information</h2>
<form onsubmit="processPayment(); return false;">
<label for="name">Full Name:</label>
<input type="text" id="name" name="name" required><br><br>
<label for="email">Email:</label>
<input type="email" id="email" name="email" required><br><br>
<label for="address">Billing Address:</label>
<textarea id="address" name="address" rows="4" required></textarea><br><br>
<label for="card">Credit Card Number:</label>
<input type="text" id="card" name="card" required><br><br>
<label for="expiry">Expiry Date:</label>
<input type="text" id="expiry" name="expiry" placeholder="MM/YY" required><br><br>
<label for="cvv">CVV:</label>
<input type="text" id="cvv" name="cvv" required><br><br>
<label for="paymentMethod">Payment Method:</label>
<select id="paymentMethod" name="paymentMethod" required>
<option value="credit_card">Credit/Debit Card</option>
<option value="upi">UPI</option>
<!-- Add more payment methods as needed -->
</select><br><br>
<button type="submit">Proceed Payment</button>
</form>
<div id="paymentResult">
<!-- Display payment result here -->
</div>
</section>
<footer>
<p>Contact us at: <a href="mailto:orders@medicinewebsite.com">orders@medicinewebsite.com</a></p>
</footer>
<script>
function processPayment() {
var paymentResultDiv = document.getElementById("paymentResult");
var paymentMethod = document.getElementById("paymentMethod").value;
// Simulate payment processing for demonstration
if (paymentMethod === "credit_card") {
paymentResultDiv.innerHTML = "<p>Payment successful! Your order is confirmed.</p>";
} else if (paymentMethod === "paypal") {
paymentResultDiv.innerHTML = "<p>You will be redirected to PayPal for payment.</p>";
// You would add actual PayPal integration code here
}
}
</script>
</body>
</html>