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appointment.php
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<?php
session_start();?>
<!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">
<meta name="description" content="">
<meta name="author" content="">
<title>Appointment</title>
<link href="vendor/bootstrap/css/bootstrap.min.css" rel="stylesheet">
<link href="vendor/metisMenu/metisMenu.min.css" rel="stylesheet">
<link href="dist/css/sb-admin-2.css" rel="stylesheet">
<link href="vendor/morrisjs/morris.css" rel="stylesheet">
<link href="vendor/font-awesome/css/font-awesome.min.css" rel="stylesheet" type="text/css">
</head>
<body>
<div id="wrapper">
<nav class="navbar navbar-default navbar-static-top" role="navigation" style="margin-bottom: 0">
<div class="navbar-header">
<button type="button" class="navbar-toggle" data-toggle="collapse" data-target=".navbar-collapse">
<span class="sr-only">Toggle navigation</span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
<a class="navbar-brand" href="index.html">Patients Dashboard</a>
</div>
<ul class="nav navbar-top-links navbar-right">
<li class="divider"></li>
<li><a href="Logout.php"><i class="fa fa-sign-out fa-fw"></i> Logout</a>
</li>
</li>
</ul>
<div class="navbar-default sidebar" role="navigation">
<div class="sidebar-nav navbar-collapse">
<ul class="nav" id="side-menu">
<li>
<a href="#.html"><i class="fa fa-dashboard fa-fw"></i> Dashboard</a>
</li>
<li>
<a href="#"><i class="fa fa-user-md fa-fw"></i> appointments<span class="fa arrow"></span></a>
<ul class="nav nav-second-level">
<li>
<a href="appointment.php">add an appointment</a>
</li>
</ul>
</li>
</li>
</ul>
</div>
</div>
</nav>
<div id="page-wrapper">
<div class="row">
<div class="col-lg-12">
<h1 class="page-header">Dashboard</h1>
</div>
<div>
<p> <h2>Welcome, Kindly Book an appointment!</h2> </p>
<div class='alert alert-info'>
<form action="func.php" method="POST">
<div class="form-group" >
<label for="usr">Full Name:</label>
<input type="text" class="form-control" id="usr" name="fullname" required>
</div>
<div class="form-group">
<label for="pwd">Age: (in years)</label>
<input type="number" class="form-control" id="pwd" name="age" min="1" max="200" required>
</div>
<div class="form-group">
<label for="pwd">Weight (in kgs):</label>
<input type="tel" class="form-control" id="pwd" name="weight" min="1" max="300" required>
</div>
<div class="form-group">
<label for="pwd">Phone No:</label>
<input type="tel" class="form-control" id="pwd" name="phone" required>
</div>
<div class="form-group">
<div class="form-group">
<label for="pwd">Next on Kin:</label>
<input type="text" class="form-control" id="pwd" name="nextofkin" required>
</div>
<label for="pwd">Address:</label>
<textarea class="form-control" id="pwd" name="address" required></textarea>
</div>
<div class="form-group">
<label for="pwd">Doctor Needed:</label>
<select required value=1 name="Specialist">
<option value="Audiologist" class="option">Audiologist - Ear Expert</option>
<option value="Allergist" class="option">Allergist - Allergy Expert</option>
<option value="Anesthesiologist" class="option">Anesthesiologist - Anesthetic Expert</option>
<option value="Cardiologist" class="option">Cardiologist - Heart Expert</option>
<option value="Dentist" class="option">Dentist - Oral Care Expert</option>
<option value="Dermatologist" class="option">Dermatologist - Skin Expert</option>
<option value="Endocrinologist" class="option">Endocrinologist - Endocrine Expert</option>
</select>
</div>
<div class="form-group">
<label for="pwd">Medical Condition / Purpose of visit:</label>
<textarea class="form-control" id="pwd" name="medcondition" required></textarea>
</div>
<div class="form-group">
<input type="submit" name="submit" class="btn btn-primary" >
<input type="reset" name="" class="btn btn-danger">
</div>
</form>
</div>
</div>
</div>
</div>
<script src="vendor/jquery/jquery.min.js"></script>
<script src="vendor/bootstrap/js/bootstrap.min.js"></script>
<script src="vendor/metisMenu/metisMenu.min.js"></script>
<script src="vendor/raphael/raphael.min.js"></script>
<script src="vendor/morrisjs/morris.min.js"></script>
<script src="data/morris-data.js"></script>
<script src="dist/js/sb-admin-2.js"></script>
</body>