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providers.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> Providers | My Clinic</title>
<link rel="stylesheet" href="style.css">
</head>
<body>
<div class="blue_line"></div>
<div class="white_line">
<a href="index.html"><img
src="./images/myclinic.PNG"
alt="my clinic logo"
height="100"
width="100"
/></a>
</div>
<div class="green_line">
<ul>
<li><a href="about.html">About us</a></li>
<li><a href="services.html">Services and specialties</a></li>
<li><a href="locations.html">Locations</a></li>
<li><a href="providers.html">Medical providers</a></li>
<li>
<a href="participating_insurance.html">Participating insurances</a>
</li>
<li><a href="contactus.html">Contact us</a></li>
</ul>
</div>
<form>
<h1>Medical Providers</h1>
<br>
<h2>Medical doctor</h2>
<input list="browsers" name="browser" id="browser">
<datalist id="browsers">
<option value="Jimmy Herbert">
<option value="Leo Hassan">
<option value="Raphael Anita">
<option value="Ernest Philip">
<option value="Ioan Jeffrey">
<option value="Aidan Kenneth">
</datalist>
<br>
<br>
<h2>Patient</h2>
<input type="text" id="first_name" name="first_name" placeholder="First name:"><br>
<input type="text" id="last_name" name="last_name" placeholder="Last name:"> <br>
<input type="radio" id="male" name="gender" value="male">
<label for="male">Male</label><br>
<input type="radio" id="female" name="gender" value="female">
<label for="female">Female</label><br>
<label for="age">Age</label><br>
<input type="number" value=" " id="age">
<br/>
<textarea name="message" rows="10" cols="30">Diagnose</textarea>
<br>
<img src="https://media.giphy.com/media/mMEkvAx25ROHmXg5RR/giphy.gif" alt="stamp" style="width: 150px;">
<input type="submit" value="Submit">
</form>
<p id="data">All data is electronic and valid without a stamp.</p>
<br>
<button type="button" value="button" onclick="window.location.href = 'index.html';" id="button_back">Back</button>
<footer> My clinic © 2020, All Rights Reserved </footer>
</body>
</html>