clinico/doctorsignup.php at master · amritsarstartups/clinico · GitHub

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<!DOCTYPE html>
<html lang="en">
<head>
	<meta charset="UTF-8">
	<title>Doctor Signup</title>
	<link href="css/bootstrap.css" rel="stylesheet">
	<script src="js/jquery.min.js"></script>
	<script src="js/bootstrap.min.js"></script>
</head>
<body>
<?php include "header_public.php" ?>
<?php include "connection.php" ?>
<div class="container">
	<h2 class="text-center">Doctor Sign Up</h2>
	<div class="col-md-3"></div>
	<div class="col-md-6">
		<form action="doctorsignup_action.php" method="post">
			<div class="form-group">
				Name
				<input type="text" class="form-control" name="name" required data-parsley-required="true"/>
			</div>
			<div class="form-group">
				Date of Birth
				<input type="date" class="form-control" name="dob" required data-parsley-required="true"/>

			</div>
			<div class="form-group">
				Email
				<input type="email" name="email" class="form-control" required data-parsley-required="true"/>
			</div>
			<div class="form-group">
				Password
				<input type="password" name="pass" class="form-control" required data-parsley-required="true"/>
			</div>
			<div class="form-group">
				Confirm Password
				<input type="password" name="cpass" class="form-control" required data-parsley-required="true"/>
			</div>

			<div class="form-group">
				Specialization
				<select name="specialization" required class="form-control">
					<option value="">[Select]</option>
					<?php
						$cc = "select * from dis_cat";
						$cc_res = mysqli_query($conn, $cc);
						while ($cc_row = mysqli_fetch_array($cc_res)) {
							?>
							<option value="<?php echo $cc_row[1] ?>"><?php echo $cc_row[1] ?></option>
							<?php
						}
					?>
				</select>

			</div>

			<div class="form-group">
				Mobile No.
				<div class="input-group">
					<span class="input-group-addon">+91</span>
					<input type="text" name="mno" id="mno" minlength="10" maxlength="10" class="form-control" required
						   data-parsley-required="true"/>
				</div>
				<input type="button" class="btn btn-success" value="Send OTP" onclick="sendotp()">
				<div id="otp">

				</div>
			</div>
			<div class="form-group">
				<input type="submit" value="SUBMIT" class="btn btn-primary"/>
				<?php
					if(isset($_REQUEST['msg']))
						echo $_REQUEST['msg'];
				?>
			</div>

		</form>
	</div>
	<div class="col-md-3"></div>
</div>
<script>
    function sendotp() {
        var mno=parseInt(document.getElementById("mno").value);
//            alert (mno);
        var xmlhttp = new XMLHttpRequest();
        xmlhttp.onreadystatechange = function() {
            if (this.readyState == 4 && this.status == 200) {
                document.getElementById("otp").innerHTML = this.responseText;
            }
        };
        xmlhttp.open("GET", "otpaction.php?mno=" + mno, true);
        xmlhttp.send();
    }
    $('#usersignup').parsley();

</script>

</body>
</html>