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new-patient.html
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new-patient.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<!-- The above 3 meta tags *must* come first in the head; any other head content must come *after* these tags -->
<title>ToHeal</title>
<!-- Css Files -->
<link href="CSS/bootstrap.css" rel="stylesheet">
<link href="CSS/font-awesome.css" rel="stylesheet">
<link href="CSS/flaticon.css" rel="stylesheet">
<link href="CSS/slick-slider.css" rel="stylesheet">
<link href="CSS/fancybox.css" rel="stylesheet">
<link href="CSS/style.css" rel="stylesheet">
<link href="CSS/color.css" rel="stylesheet">
<link href="CSS/responsive.css" rel="stylesheet">
<!-- HTML5 shim and Respond.js for IE8 support of HTML5 elements and media queries -->
<!-- WARNING: Respond.js doesn't work if you view the page via file:// -->
<!--[if lt IE 9]>
<script src="https://oss.maxcdn.com/html5shiv/3.7.2/html5shiv.min.js"></script>
<script src="https://oss.maxcdn.com/respond/1.4.2/respond.min.js"></script>
<![endif]-->
</head>
<body>
<!--// Main Wrapper \\-->
<div class="careplus-main-wrapper">
<!--// Header \\-->
<header id="careplus-header" class="careplus-header-one">
<!--// Main Header \\-->
<div class="careplus-main-header">
<div class="container">
<div class="row">
<aside class="col-md-3"><a href="index.html" class="careplus-logo"><img src="IMG/logoTUN.png" alt=""></a></aside>
<aside class="col-md-9">
<ul class="careplus-infolist"></ul>
<a href="index.html#banner" class="careplus-top-btn careplus-bgcolor">sign in</a>
<a href="sign-up.html" class="careplus-top-btn careplus-bgcolor-two">sign up</a>
</aside>
</div>
</div>
</div>
<!--// Main Header \\-->
<!--// Navigation Section \\-->
<div class="careplus-navigation-section careplus-bgcolor">
<div class="container">
<div class="row">
<div class="col-md-12">
<div class="careplus-navinner">
<nav class="navbar navbar-default">
<div class="navbar-header">
<button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-target="#navbar-collapse-1" aria-expanded="true">
<span class="sr-only">Toggle navigation</span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
</div>
<div class="collapse navbar-collapse" id="navbar-collapse-1">
<ul class="nav navbar-nav">
<li><a href="index.html">Home</a></li>
<li><a href="doctors-list.html">Doctors</a>
</li>
<li><a href="blog.html">Blogs</a></li>
<li class="careplus-megamenu-li"><a href="news.html">News</a></li>
<li class="careplus-megamenu-li"><a href="#footer">Contact us</a></li>
</ul>
</div>
</nav>
<ul class="careplus-user-list">
<li><a href="#" class="careplus-color-two fa fa-search" data-toggle="modal" data-target="#searchmodal"></a></li>
<!-- <li><a href="#" class="careplus-color-two fa fa-user"></a>
<div class="careplus-user-box">
<a href="new-patient.html">add patient</a><br/>
<a href="patient-list.html">My patients</a><br/>
<a href="logout.html">logout</a>
</div>
</li> -->
</ul>
</div>
</div>
</div>
</div>
</div>
<!--// Navigation Section \\-->
</header>
<!--// Header \\-->
<!--// SubHeader \\-->
<div class="careplus-subheader">
<div class="careplus-subheader-image">
<span class="careplus-dark-transparent"></span>
<div class="container">
<div class="row">
<div class="col-md-12">
<h1>Add a new Patient</h1>
<span>Enter the necessary information for the new patient</span>
</div>
</div>
</div>
</div>
<div class="careplus-breadcrumb">
<div class="container">
<div class="row">
<div class="col-md-12">
<ul>
<li><a href="index.html">Homepage</a></li>
<li>New Patient</li>
</ul>
</div>
</div>
</div>
</div>
</div>
<!--// SubHeader \\-->
<!--// Main Content \\-->
<div class="careplus-main-content">
<!--// Main Section \\-->
<div class="careplus-main-section">
<div class="container">
<div class="row">
<div class="col-md-12">
<div class="careplus-appointment-request-form">
<form>
<ul>
<li class="careplus-appointment-fullform"> <span>CIN:</span> </li>
<li style="width: 50%;">
<input placeholder="CIN" tabindex="0" type="text">
</li>
<li class="careplus-appointment-fullform"> <span>Name:</span> </li>
<li style="width: 50%;">
<input placeholder="First Name" tabindex="0" type="text">
</li>
<li style="width: 50%;">
<input placeholder="Last Name" tabindex="0" type="text">
</li>
<li class="careplus-appointment-fullform"> <span>Gender:</span> </li>
<li class="careplus-appointment-fullform">
<div class="careplus-radio">
<div class="careplus-radio-partition">
<input id="male" name="gender" checked="checked" value="male" type="radio">
<label for="male">Male</label>
</div>
<div class="careplus-radio-partition">
<input id="female" name="gender" value="female" type="radio">
<label for="female">Female</label>
</div>
</div>
</li>
<li class="careplus-appointment-fullform"> <span>Email/Phone:</span> </li>
<li class="careplus-appointment-fullform">
<input placeholder="Email" tabindex="0" type="text">
</li>
<li class="careplus-appointment-fullform"> <span>Address:</span> </li>
<li class="careplus-appointment-fullform">
<input placeholder="Street Adress" tabindex="0" type="text">
</li>
<li style="width: 50%;">
<input placeholder="City" tabindex="0" type="text">
</li>
<li style="width: 50%;">
<div class="careplus-appointment-select">
<select>
<option value="Tunis">Tunis</option>
<option value="Sousse">Sousse</option>
<option value="Monastir">Monastir</option>
</select>
</div>
</li>
<li class="careplus-appointment-fullform"> <span>Notes/Observation</span> </li>
<li class="careplus-appointment-fullform"><textarea name="Notes" placeholder=""></textarea></li>
<li><label><input value="Submit Now" type="submit"><span></span></label></li>
</ul>
</form>
</div>
</div>
</div>
</div>
</div>
<!--// Main Section \\-->
</div>
<!--// Main Content \\-->
<!--// Footer \\-->
<footer id="careplus-footer" class="careplus-footer-one">
<span class="careplus-footer-transparent"></span>
<!--// Footer Widget \\-->
<div class="careplus-footer-widget">
<div class="container">
<div class="row">
<!--// Widget Contact Info \\-->
<aside class="col-md-4 widget widget_contact_info">
<a href="index.html" class="footer-logo"><img src="IMG/logoTUN.png" alt=""></a>
<p>Always ready to help.</p>
<ul>
<li>
<h6>Emergency:</h6>
<span>199</span>
</li>
<li>
<h6>COVID-19 emergency:</h6>
<span>190</span>
</li>
<li>
<h6>Green Number:</h6>
<span>80-mana3rfouch</span>
</li>
</ul>
</aside>
<!--// Widget Contact Info \\-->
<!--// Widget Useful Link \\-->
<aside class="col-md-4 widget widget_useful_link">
<h2 class="careplus-footer-title">Useful Links</h2>
<ul>
<li><a href="404.html">Tunisian Health Misitry</a></li>
<li><a href="404.html">COVID-19</a></li>
</ul>
</aside>
<!--// Widget Useful Link \\-->
<!--// Widget Newsletter \\-->
<aside class="col-md-4 widget widget_newsletter">
<h2 class="careplus-footer-title">Our Newsletter</h2>
<p>Nunc ut volutpat ex. Morbi risus elit, mattis in mi ne mollis blandit erat.</p>
<form>
<ul>
<li><input value="Your Name" onblur="if(this.value == '') { this.value ='Your Name'; }" onfocus="if(this.value =='Your Name') { this.value = ''; }" tabindex="0" type="text"></li>
<li><input value="Your Email" onblur="if(this.value == '') { this.value ='Your Email'; }" onfocus="if(this.value =='Your Email') { this.value = ''; }" tabindex="0" type="email"></li>
<li><label><input type="submit" value="Subscribe"><span></span></label></li>
</ul>
</form>
</aside>
<!--// Widget Newsletter \\-->
</div>
</div>
</div>
<!--// Footer Widget \\-->
<!--// Copy Right \\-->
<div class="careplus-copyright">
<div class="container">
<div class="row">
<div class="col-md-12">
<p><i class="fa fa-copyright"></i> 2020, All Right Reserved - by <a href="index-html">Us.</a></p>
<a href="#" class="careplus-back-top"><i class="fa fa-angle-up"></i></a>
<ul class="careplus-footer-social">
<li><a href="https://www.facebook.com/" class="fa fa-facebook-square"></a></li>
<li><a href="https://twitter.com/login" class="fa fa-twitter-square"></a></li>
<li><a href="https://pk.linkedin.com/" class="fa fa-linkedin-square"></a></li>
<li><a href="https://plus.google.com/" class="fa fa-google-plus-square"></a></li>
</ul>
</div>
</div>
</div>
</div>
<!--// Copy Right \\-->
</footer>
<!--// Footer \\-->
<div class="clearfix"></div>
</div>
<!--// Main Wrapper \\-->
<!-- Modal -->
<div class="modal fade searchmodal" id="searchmodal" tabindex="-1" role="dialog">
<div class="modal-dialog" role="document">
<div class="modal-body">
<a href="#" class="careplus-close-btn" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></a>
<form>
<input type="text" value="Type Your Keyword" onblur="if(this.value == '') { this.value ='Type Your Keyword'; }" onfocus="if(this.value =='Type Your Keyword') { this.value = ''; }">
<input type="submit" value="">
<i class="fa fa-search"></i>
</form>
</div>
</div>
</div>
<!-- jQuery (necessary for JavaScript plugins) -->
<script type="text/javascript" src="JS/jquery.js"></script>
<script type="text/javascript" src="JS/bootstrap.min.js"></script>
<script type="text/javascript" src="JS/slick.slider.min.js"></script>
<script type="text/javascript" src="JS/isotope.min.js"></script>
<script type="text/javascript" src="JS/jquery.countdown.min.js"></script>
<script type="text/javascript" src="JS/fancybox.pack.js"></script>
<script type="text/javascript" src="JS/progressbar.js"></script>
<script type="text/javascript" src="JS/counter.js"></script>
<script type="text/javascript" src="JS/functions.js"></script>
</body>
</html>