198 lines
6.5 KiB
PHP
198 lines
6.5 KiB
PHP
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<html lang="en">
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<head>
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<!--<link href="css/multiselect.css" rel="stylesheet" type="text/css">
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<script src="js/multiselect.js"></script>-->
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<script src="includes/css-js/functions.js"></script>
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<!-- bootstrap & fontawesome -->
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<link rel="stylesheet" href="assets/font-awesome/4.5.0/css/font-awesome.min.css" />
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<link rel="stylesheet" href="assets/css/bootstrap.min.css" />
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<link rel="stylesheet" type="text/css" href="css/bootstrap-dialog.min.css" />
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<link href="css/flexigrid.css" rel="stylesheet" />
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<link rel="stylesheet" type="text/css" href="css/bootstrap-theme.min.css"/>
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<link rel="stylesheet" type="text/css" href="css/bootstrap-datepicker.css"/>
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<!-- page specific plugin styles -->
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<!-- text fonts -->
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<link rel="stylesheet" href="assets/css/fonts.googleapis.com.css" />
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<!-- ace styles -->
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<link rel="stylesheet" href="assets/css/ace.min.css" class="ace-main-stylesheet" id="main-ace-style" />
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<link rel="stylesheet" href="assets/css/ace-skins.min.css" />
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<link rel="stylesheet" href="assets/css/ace-rtl.min.css" />
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<script src="assets/js/jquery-2.1.4.min.js"></script>
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<script type="text/javascript">
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if ('ontouchstart' in document.documentElement)
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document.write("<script src='assets/js/jquery.mobile.custom.min.js'>" + "<" + "/script>");
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</script>
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<script src="assets/js/bootstrap.min.js"></script>
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<!-- page specific plugin scripts -->
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<script src="assets/js/jquery-ui.custom.min.js"></script>
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<script src="assets/js/jquery.ui.touch-punch.min.js"></script>
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<script src="assets/js/jquery.easypiechart.min.js"></script>
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<script src="assets/js/jquery.sparkline.index.min.js"></script>
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<script src="assets/js/jquery.flot.min.js"></script>
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<script src="assets/js/jquery.flot.pie.min.js"></script>
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<script src="assets/js/jquery.flot.resize.min.js"></script>
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<script src="assets/js/autosize.min.js"></script>
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<!-- ace scripts -->
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<script src="assets/js/ace-elements.min.js"></script>
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<script src="assets/js/ace.min.js"></script>
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<!-- inline scripts related to this page -->
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<script type="text/javascript" src="js/bootstrap.min.js"/></script>
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<script type="text/javascript" src="js/bootstrap-filestyle.min.js"/></script>
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<script type="text/javascript" src="js/bootstrap-dialog.min.js"/></script>
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<script type="text/javascript" src="js/bootstrap-datepicker.js"/></script>
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<script type="text/javascript" src="js/jquery.dataTables.min.js"/></script>
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<script src="js/jquery-migrate.js"></script>
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<script src="js/flexigrid.js" langugage="Javascript"/></script>
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<!-- ace settings handler -->
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<script src="assets/js/ace-extra.min.js"></script>
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<!--online css-->
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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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<style>
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body, html {
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height: 100%;
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margin: 0;
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}
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.bg {
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/* The image used */
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background-image: url("doctor.jpg");
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/* Full height */
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height: 100%;
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/* Center and scale the image nicely */
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background-position: center;
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background-repeat: no-repeat;
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background-size: cover;
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}
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.shadow{
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background-color:rgba(0,0,0,0.7);
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height:100%;
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}
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a{
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all: unset;
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}
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</style>
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</head>
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<body>
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<div class="container-fluid">
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<div class="bg">
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<div class="shadow">
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<div class="container col-sm-offset-2 col-sm-4" style="color: #ffffff; margin-top:100px; " >
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<h1>We provide</h1>
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<h1> Best Medical Services</h1>
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<h3>Join With Us</h3>
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</div>
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<div class="container col-sm-6 ">
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<div style="margin:auto; position: relative; background-color:white; border-color:black; color:black; width:450px; padding:25px; margin-top:60px;">
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<form method="post" name="company_profile" id="company_profile">
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<center><h2><b>Sign Up</b></h2></center>
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<div class="form-group" style="margin-top: 10px">
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<input type="text" class="form-control" id="name" placeholder="Enter name" name="name" style="width:400px;">
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</div>
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<div class="form-group">
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<input type="text" class="form-control" id="code" placeholder="Enter Code" name="code" style="width:400px;">
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</div>
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<div class="form-group">
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<input type="text" class="form-control" id="address" placeholder="Enter Address" name="address" style="width:400px;">
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</div>
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<div class="form-group">
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<input type="text" class="form-control" id="contact_name" placeholder="Enter contact name" name="contact_name" style="width:400px;">
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</div>
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<div class="form-group">
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<input type="text" class="form-control" id="phone" placeholder="Enter Phone" name="phone" style="width:400px;">
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</div>
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<div class="form-group">
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<input type="text" class="form-control" id="email" placeholder="Enter email" name="email" style="width:400px;">
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</div>
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<div class="form-group">
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<input type="url" class="form-control" id="website" placeholder="Enter Website " name="website" style="width:400px;">
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</div>
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<button type="save" onclick="validate();" class="btn btn-info" style="position:relative; left:170px;">Sign Up</button>
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<button type="button" class="btn btn-info" style="position:relative; left:170px;"><a href="sign_in.php">Existing User? </a></button>
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</form>
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</div>
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</div>
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</div>
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</div>
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</div>
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</body>
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</html>
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<script>
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function validate(){
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var name = $('#name').val();
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if(name == ''){
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BootstrapDialog.alert('Please Enter Name.!!!');
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return false;
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}
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var code = $('#code').val();
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if(code == ''){
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BootstrapDialog.alert('Please Enter code.!!!');
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return false;
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}
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var address = $('#address').val();
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if(address == ''){
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BootstrapDialog.alert('Please Enter address.!!!');
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return false;
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}
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var contact_name = $('#contact_name').val();
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if(contact_name == ''){
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BootstrapDialog.alert('Please Enter contact_name.!!!');
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return false;
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}
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var phone = $('#phone').val();
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if(phone == ''){
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BootstrapDialog.alert('Please Enter phone.!!!');
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return false;
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}
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var email = $('#email').val();
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if(email == ''){
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BootstrapDialog.alert('Please Enter email.!!!');
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return false;
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}
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var website = $('#website').val();
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if(website == ''){
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BootstrapDialog.alert('Please Enter website.!!!');
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return false;
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}
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save();
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}
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function save(){
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$.ajax({
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type:'POST',
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data:$("#company_profile").serialize(),
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url:'registration_script.php',
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success:function(data) {
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},
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error:function(data){
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},
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});
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$('#company_profile').modal("hide");
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}
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</script> |