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doctor_sign_up.html
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<!DOCTYPE html>
<html lang="en-US">
<head>
<!-- META TAGS -->
<meta charset="UTF-8"/>
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<!-- Title -->
<title>Doc Seek</title>
<!-- Font CSS Link -->
<link href='http://fonts.googleapis.com/css?family=Droid+Sans' rel='stylesheet' type='text/css'>
<!-- Font CSS Link -->
<!-- Start CSS Link -->
<link type="text/css" rel="stylesheet" href="assets/css/bootstrap.css">
<link type="text/css" rel="stylesheet" href="assets/css/bootstrap-responsive.css">
<link type="text/css" rel="stylesheet" href="assets/css/graha-pink.css">
<link type="text/css" id="main-style" rel="stylesheet" href="#">
<link type="text/css" rel="stylesheet" href="assets/css/jquery.mCustomScrollbar.css">
<link rel="stylesheet" href="assets/css/flexslider.css" type="text/css" media="screen"/>
<link rel="stylesheet" href="assets/css/jquery-ui.css" type="text/css" media="screen"/>
<link rel="stylesheet" href="assets/css/palette_switcher.css" type="text/css" media="screen"/>
<link rel="stylesheet" href="assets/css/toggles.css" type="text/css" media="screen"/>
<!-- End CSS Link -->
<script type="text/javascript" src="assets/js/jquery.js"></script>
<script>
$(document).ready(function(){
$('#dsubmit').click(function (e) {
e.preventDefault();
$.post("php/doctor_signup.php", $('#dform').serialize(),function(confirm){
$('#adoctor').text(confirm);
$('#dreset').click(function (e){
window.location.href="doctor_sign_up.html";
});
});
return false;
});
})
</script>
<script>
(function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
})(window,document,'script','//www.google-analytics.com/analytics.js','ga');
ga('create', 'UA-53604114-1', 'auto');
ga('send', 'pageview');
</script>
</head>
<body>
<!--Menu wrapper Start-->
<div id="menu-wrapper">
<div class="container">
<div class="menu-container">
<div class="top-menu navbar">
<div class="navbar-inner">
<div class="moblogo visible-phone visible-tablet">
<a href="#"><img src="assets/img/docseek_logo.png" alt="logo"></a>
</div>
<a class="btn btn-navbar" data-toggle="collapse" data-target=".nav-collapse">
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</a>
<ul class="nav nav-collapse collapse">
<li><a href="index.html">Doc Seek</a>
</li>
<li><a href="features.html">features</a>
</li>
<li>
<div class="home-logo">
<div>
<a href="index.html"><img src="assets/img/docseek_logo.png" alt="logo"></a>
</div>
</div>
</li>
<li><a href="contact.html">contact</a></li>
<li><a href="sign_in.html">sing in</a></li>
</ul>
</div>
</div>
</div>
</div>
</div>
<!--Menu wrapper End-->
<div id="content-wrapper">
<!--Home content start-->
<div class="container">
<div id="single-content">
<div class="row">
<div class="span8">
<div class="heading-area">
<h2>Doctor Sign Up</h2>
</div>
<div class="single-wrapper clearfix">
<form class="list-form" action="php/doctor_signup.php" method="post" id="dform" >
<a href="#" id="adoctor"></a>
<br>
<label>Full Name :</label>
<input class="span7" type="text" name="name" required>
<label>PMDC No :</label>
<input class="span7" type="text" name="pmdcno" required>
<label>Email :</label>
<input class="span7" type="text" name="email" required>
<label>Password :</label>
<input class="span7" type="password" name="pass" required>
<label>Hospital Name:</label>
<input class="span7" type="text" name="hospitalname" required>
<label>Specialized In:</label>
<select class="span7" name="specialist" required>
<option value=""></option>
<option value="Anaesthetist">Anaesthetist</option>
<option value="Biotechnologist">Biotechnologist</option>
<option value="Cardiologist">Cardiologist</option>
<option value="Chest Specialist">Chest Specialist</option>
<option value="Children Specialist">Children Specialist</option>
<option value="Dental Surgeon">Dental Surgeon</option>
<option value="Dermatologist">Dermatologist</option>
<option value="E.N.T Specialist">E.N.T Specialist</option>
<option value="Epidemiologist">Epidemiologist</option>
<option value="Eye Specialist">Eye Specialist</option>
<option value="Gynaecologist">Gynaecologist</option>
<option value="Medical Specialist">Medical Specialist</option>
<option value="Microbiologist">Microbiologist</option>
<option value="Neuro Surgeon">Neuro Surgeon</option>
<option value="Nutritionist">Nutritionist</option>
<option value="Oral & Maxillofacial Surgeon">Oral & Maxillofacial Surgeon</option>
<option value="Orthopaedic Specialist">Orthopaedic Specialist</option>
<option value="Orthopaedic Surgeon">Orthopaedic Surgeon</option>
<option value="Paediatrician">Paediatrician</option>
<option value="Pathologist">Pathologist</option>
<option value="Pharmacist">Pharmacist</option>
<option value="Physician">Physician</option>
<option value="Physiotherapist">Physiotherapist</option>
<option value="Psychiatrist">Psychiatrist</option>
<option value="Radiologist">Radiologist</option>
<option value="Skin Specialist">Skin Specialist</option>
<option value="Specialist">Specialist</option>
<option value="Surgeon">Surgeon</option>
<option value="Surgical Specialist">Surgical Specialist</option>
<option value="T.B Specialist">T.B Specialist</option>
<option value="Trauma Surgeon">Trauma Surgeon</option>
</select>
<label>Contact No:</label>
<input class="span7" type="text" name="contactNum" required>
<label>Working Hours:</label>
<select class="span7" name="workingHours_from" required>
<option value="">From</option>
<option value="9AM">9AM</option>
<option value="10AM">10AM</option>
<option value="11AM">11AM</option>
<option value="12PM">12PM</option>
<option value="1PM">1PM</option>
<option value="2PM">2PM</option>
</select>
<br><br>
<select class="span7" name="workingHours_to" reqiured>
<option value="">To</option>
<option value="12PM">12PM</option>
<option value="1PM">1PM</option>
<option value="2PM">2PM</option>
<option value="3PM">3PM</option>
<option value="4PM">4PM</option>
<option value="5PM">5PM</option>
</select>
<label>Contact Time:</label>
<select class="span7" name="contactHours_day" required>
<option value="">Day</option>
<option value="Monday">Monday</option>
<option value="Tuesday">Tuesday</option>
<option value="Wednesday">Wednesday</option>
<option value="Thursday">Thursday</option>
<option value="Friday">Friday</option>
<option value="Saturday">Saturday</option>
<option value="Sunday">Sunday</option>
</select>
<br><br>
<select class="span7" name="contactHours_time" reqiured>
<option value="">Time</option>
<option value="9AM">9AM</option>
<option value="10AM">10AM</option>
<option value="11AM">11AM</option>
<option value="12PM">12PM</option>
<option value="1PM">1PM</option>
<option value="2PM">2PM</option>
<option value="3PM">3PM</option>
<option value="4PM">4PM</option>
<option value="5PM">5PM</option>
</select>
<label>Gender :</label>
<div class="span7">
<input type="radio" name="gender" style="width:20px;height:1em;font-size:20px" value="male" checked><font style="font-size:15px">Male</font></input>
<input type="radio" name="gender" style="width:20px;height:1em;font-size:20px" value="female" required><font style="font-size:15px">Female</font></input>
</div><br>
<div class="form-bt">
<input type="reset" id="dreset" value="Reset" class="btn btn-main ctr">
<input type="submit" id="dsubmit" value="Create account" class="btn btn-main ctr">
</div>
</form>
</div>
</div>
<div class="span4">
<div class="contact-agents clearfix">
<h2>Contact us</h2>
<div class="contact-agents-data">
<h4>Contact address</h4>
<div class="name">
1st floor KPITBoard,
</div>
<div class="name">
Deans Trade center Peshawar.
</div>
<div class="email">
<a href="mailto:hina@labandroid.com">hina@labandroid.com</a>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<!--Home content end-->
</div>
<!--Footer area start-->
<div class="footer-wrapper clearfix">
<div class="container">
<div class="row">
<div class="span10">
<div class="footer">
© 2014 DocSeek.com | All rights reserved.
</div>
</div>
</div>
</div>
</div>
<!-- Start JS Link -->
<script src="assets/js/modernizr.js"></script>
<script type="text/javascript" src="assets/js/jquery.js"></script>
<script type="text/javascript" src="assets/js/jquery.easing.1.3.js"></script>
<script type="text/javascript" src="assets/js/bootstrap.js"></script>
<script type="text/javascript" src="http://maps.googleapis.com/maps/api/js?key=AIzaSyC_aOgBOH5a6C5rWkb9Sb2Q3IpVJD7DUiQ&sensor=false"></script>
<script type="text/javascript" src="assets/js/gmap3.infobox.min.js"></script>
<script type="text/javascript" src="assets/js/gmap3.min.js"></script>
<script type="text/javascript" src="assets/js/gmap3.clusterer.js"></script>
<script src="assets/js/jquery-ui.js"></script>
<script type="text/javascript" src="assets/js/jquery.cookie.js"></script>
<script type="text/javascript" src="assets/js/switcher.js"></script>
<script defer src="assets/js/jquery.prettyPhoto.js"></script>
<script defer src="assets/js/jquery.flexslider.js"></script>
<script defer src="assets/js/custom.js"></script>
<script defer src="assets/js/toggles.js"></script>
<script src="assets/js/jquery.mCustomScrollbar.js"></script>
<script type="text/javascript" src="assets/js/jquery.ui.touch-punch.min.js"></script>
<script src="assets/js/jquery.panorama.js"></script>
<script>$('#widget').draggable();</script>
<!-- End JS Link -->
</body>
</html>