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register.html
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register.html
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<?php
$err = '';
if(isset($_GET["valerrno"])){
$n = $_GET["valerrno"];
if($n==0){
$err = "Please fill all details!";
}
if($n==1){
$err = "Passwords Mismatch!";
}
if($n==3){
$err = "Account already Exists on this Email!";
}
}
?>
<!DOCTYPE html>
<html lang="en" >
<head>
<meta charset="UTF-8">
<title>Register</title>
<link rel="stylesheet" href="./css/register.css">
</head>
<body>
<!-- partial:index.partial.php -->
<div class="form_wrapper">
<div class="form_container">
<div class="title_container">
<h2>Patient Registration</h2>
</div>
<div class="row clearfix">
<div class="">
<form method="POST" action="register.php">
<div><?= $err!=""? "<div style='padding:10px;color:red'>$err</div>":""?></div>
<div class="row clearfix">
<div class="col_half">
<div class="input_field"> <span><i aria-hidden="true" class="fa fa-user"></i></span>
<input type="text" name="fname" placeholder="First Name" />
</div>
</div>
<div class="col_half">
<div class="input_field"> <span><i aria-hidden="true" class="fa fa-user"></i></span>
<input type="text" name="lname" placeholder="Last Name" required />
</div>
</div>
</div>
<div class="input_field"> <span><i aria-hidden="true" class="fa fa-envelope"></i></span>
<input type="email" name="email" placeholder="Email" required />
</div>
<div class="input_field"> <span><i aria-hidden="true" class="fa fa-lock"></i></span>
<input type="password" name="password" placeholder="Password" required />
</div>
<div class="input_field"> <span><i aria-hidden="true" class="fa fa-lock"></i></span>
<input type="password" name="repassword" placeholder="Re-type Password" required />
</div>
<div class="input_field"> <span><i aria-hidden="true" class="fa "><b>+91</b></i></span>
<input type="text" name="phone" placeholder="Phone No." required />
</div>
<div class="input_field radio_option">
<input type="radio" name="gender" value="male" id="rd1" required>
<label for="rd1">Male</label>
<input type="radio" name="gender" value="female" id="rd2" required>
<label for="rd2">Female</label>
</div>
<!--<div class="input_field select_option">
<select>
<option>Select a country</option>
<option>Option 1</option>
<option>Option 2</option>
</select>
<div class="select_arrow"></div>
</div>
<div class="input_field checkbox_option">
<input type="checkbox" id="cb1">
<label for="cb1">I agree with terms and conditions</label>
</div>
<div class="input_field checkbox_option">
<input type="checkbox" id="cb2">
<label for="cb2">I want to receive the newsletter</label>
</div>-->
<input class="button" name="register" type="submit" value="Register" />
</form>
</div>
</div>
</div>
</div>
<p class="credit"><a href="http://www.designtheway.com" target="_blank"></a></p>
<!-- partial -->
<script src='https://use.fontawesome.com/4ecc3dbb0b.js'></script>
</body>
</html>