125 lines
3.3 KiB
HTML
125 lines
3.3 KiB
HTML
<!DOCTYPE html>
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{% load widget_tweaks %}
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<html lang="en" dir="ltr">
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<head>
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<meta charset="utf-8">
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<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
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<title>LazyCoder || sumit</title>
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<style type="text/css">
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body {
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color: #aa082e;
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background-color: #b6bde7;
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font-family: 'Roboto', sans-serif;
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}
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a:link {
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text-decoration: none;
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}
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.note {
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text-align: center;
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height: 80px;
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background: -webkit-linear-gradient(left, #0072ff, #8811c5);
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color: #fff;
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font-weight: bold;
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line-height: 80px;
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}
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.form-content {
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padding: 5%;
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border: 1px solid #ced4da;
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margin-bottom: 2%;
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}
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.form-control {
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border-radius: 1.5rem;
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}
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.btnSubmit {
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border: none;
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border-radius: 1.5rem;
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padding: 1%;
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width: 20%;
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cursor: pointer;
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background: #0062cc;
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color: #fff;
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}
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</style>
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</head>
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<body>
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{% include "hospital/navbar.html" %}
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<br>
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<br>
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<br>
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<br>
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<!--- signup page for patient by admin(sumit) ---------->
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<form method="post" enctype="multipart/form-data">
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{% csrf_token %}
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<div class="container register-form">
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<div class="form">
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<div class="note">
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<p>Register to Hospital</p>
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</div>
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<div class="form-content">
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<div class="row">
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<div class="col-md-6">
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<div class="form-group">
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{% render_field userForm.first_name class="form-control" placeholder="First Name" %}
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</div>
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<div class="form-group">
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{% render_field userForm.username class="form-control" placeholder="Username" %}
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</div>
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<div class="form-group">
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{% render_field patientForm.address class="form-control" placeholder="Address" %}
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</div>
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<div class="form-group">
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{% render_field patientForm.symptoms class="form-control" placeholder="Symptoms" %}
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</div>
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<div class="form-group">
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{% render_field patientForm.profile_pic required="required" class="form-control" placeholder="Profile Picture" %}
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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{% render_field userForm.last_name class="form-control" placeholder="Last Name" %}
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</div>
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<div class="form-group">
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{% render_field userForm.password class="form-control" placeholder="Password" %}
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</div>
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<div class="form-group">
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{% render_field patientForm.mobile class="form-control" pattern="[6789][0-9]{9}" placeholder="Mobile Number" %}
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</div>
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<div class="form-group">
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{% render_field patientForm.assignedDoctorId class="form-control" placeholder="Doctor" %}
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</div>
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</div>
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</div>
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<button type="submit" class="btnSubmit">Register</button>
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<div class="text-center">Already have an account? <a href="patientlogin">Login here</a></div>
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</div>
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</div>
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</div>
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</form>
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{% include "hospital/footer.html" %}
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</body>
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<!--
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developed By : sumit kumar
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facebook : fb.com/sumit.luv
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youtube : youtube.com/lazycoders
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-->
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</html>
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